Consumption of the lungs, or, Decline : the causes, symptoms, and rational treatment with the means of prevention

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CONSUMPTION

OF THE LUNGS,

DECLINE:

THE CAUSES, SYMPTOMS, AND RATIONAL TREATMENT.

THE MEANS OF PREVENTION.

T. H. YEOMAN, M.D.

B Y A B

O S T O N PHYSICIAN

BOSTON AND CAMBRIDGE:

JAMES MUNROE AND COMPANY
18 5 0.

Entered, according to Act of Congress. In the year 1850, By James Munroe
and Company, in the Clerk's Office of the District Court of the District of
Massachusetts.

WRIGHT AND HASTY, PRINTERS, 3 WATER STREET.

PREFACE.

The rmcleus of this small volume was a series of papers, published
in 1847, in a London periodical of considerable circulation. Since that
date, many applications have been made to the publisher and to the
author for the articles in a collected form.

In thus presenting his work to the public, the author ventures to
add, that daily and extensive practice in the treatment of Consumption
enables him to express earnestly, but not arrogantly, the confidence he
reposes in, and the success which has attended, the rational treatment
he advocates for the amelioration and prevention of this melancholy
and pitiless disease.

PREFACE

BY THE AMERICAN EDITOR.

The simplicity, good sense, and practical character of this little work
have induced the publishers to issue an American edition. In regard
to a disease which is so fatally interesting to a large portion of man-
kind it is desirable that correct ideas should exist so far as the present
condition of medical science can furnish them. Its insidious approach,
the uncertainty of its earliest indications, its slow progress and fatal
termination in so large a proportion of cases, renders it peculiarly open
to the treacherous promises of Quackery, and renders people distrustful
of the aid which science can afford. To give to the popular reader a
knowledge of the true nature of the disease, a general idea of its his-
tory, course, and terminations, of the habits of life which tend to de-
velope or to check it, together with those remedies which on the whole
have been found most useful to mitigate its symptoms, or to stay its
progress, has been the aim of the author. And in this he has been
most eminently successful.

There are few evils in this world so inevitable that people will sit
patiently down and await their approach without a struggle to avert
them. When science says that it can do no more, or it is obvious that
all its attempts fail, the sick man will turn to the first delusive hope
which is presented to him, no matter under how absurd or offensive a

shape it is presented. Of this trait in human nature, quackery avails
1*

VI PREFACE.

itself, and is often the occasion of as great suffering as the disease,
the more so that it is unnecessary. By leading the public to a cor-
rect understanding of the disease they will be made to comprehend
the difficulties with which the medical man has to contend to know
how much and what kind of aid they are to expect, and to see that if
they do not get the benefit which they hoped for from intelligent and
educated men of the profession, it is not to be found in the specious
pretensions of charlatanism. It will establish confidence in the opin-
ions of medical men, and save many an unhappy sufferer from torment-
ing himself or from being tormented by others with treatment which
can never avail.

Boston, November, 1850.

CONSUMPTION.

Consumption, Decline, or Phthisis, is the plague-
spot of our climate ; amongst diseases it is the most
frequent and the most fatal ; it is the destroying
an "el who claims a fourth of all who die.

Does the individual exist who has not some special
interest in every attempt to an-est its ravages ? Is
there a family without anxiety, lest some loved Rela-
tive or connection should fall a victim to its ruthless
arm ?

I have reason to believe that the nature of con-
sumption is, at this day, but little understood by the
non-professional public, who, it might be supposed,
have an all-sufficient cause for obtaining every infor-
mation concerning the disease : until within the last
few years — until the immortal Laennec made his im-
portant discoveries — it was imperfectly or incorrectly
understood by the medical public. Cullen, the great
nosolo^ist of the last generation, considered it as a
sequel of luemoptys ; s (spitting of blood) ; and others,
that it was a disease of inflammation, or a result of
inflammation. The latter is the popular, but errone-

8 CONSUMPTION.

ous, opinion at the present time ; I anticipate what I
shall presently demonstrate, and say, that without the
germ of the disease be already deposited in the lungs ;
without the germ of the disease be inherent in the
system; without the system be pre-disposed to the
disease, inflammation after inflammation would never
induce tibcular consumption: in other words, in-
flammation can never cause consumption in a healthy
constitution.

What is it, then, that renders hundreds of thou-
sands of our fellow creatures of an " unhealthy consti-
tution," as regards this disease ? It is scrofula, or,
as it is termed in reference to phthisis, tubercle, or
tuberculous disease.

TUBERCLES.

Tubercles are peculiar morbid or adventitious mat-
ters, deposited in the substance of an organ, foreign to
its normal or natural structure ; depending upon un-
natural secretion, or imperfect nutrition ; and termi-
nating in the wasting or destruction of the organ.
They exist not only in the lungs, but also in the
glands of the mesentery, the mediastinum, the neck,
and the groin ; and sometimes they are discovered in
the heart, the liver, and the uterus ; in fact, in every
part of the body that is capable of being affected by
scrofula.

It is upon the condition and progress of these tuber-
cles that the different stages of consumption depend,

TUBERCLES. 9

and by their advancement or arrest the symptoms are
influenced and regulated. I shall, therefore, endeavor
to describe, in the most simple language, the career
of tubercles of that form in which they are more fre-
quently found in the lungs, namely, miliary tubercles ;
and in doing so I shall notice them as they exist at
three different periods, or stages.

In the first stage, these adventitious deposits are in
the form of a small round body, similar to a millet
seed, of a gray color, and nearly transparent ; they
are firm and gritty to the touch, but, if pressed be-
tween the fingers, they crumble, or break down, like
a morsel of dried mortar, or dried putty ; they are
strongly adherent to the structure of the lungs, and
are more commonly found in the cellular texture,
or loose tissue which separates the bronchial, or air,
cells from each other. In number they may range
from four, or six, to twelve, to as many thousands ; I
have made many examinations in which they were so
profusely studded, that dividing the lung with a knife,
gave the feeling of cutting through friable earthy mat-
ter, rather than the soft, yielding structure of ordi-
nary lung. According to Thenard's analysis, they
consist of

Animal matter, principally fibrine and gelatine . . 98 . 15

Muriate of soda, phosphate of lime 1 . 85

Oxide of iron, a few traces.

In the second stage, they have increased considera-
bly in size, by additions to their external surface; and,

10 CONSUMPTION.

as far as my own observations have gone, the fewer
they are in number, the greater size are they capable
of acquiring, so that sometimes they attain the size of
an almond : their color also undergoes a change, and
they now assume, especially at the centre, a yellow
tint, which gradually spreads towards the whole cir-
cumference. As they increase they become more
closely approximated to each other, and, by successive
growths or crops, which spring up between the inter-
stices of the more matured tubercles, that part of the
lung in which they are situated is studded with large,
yellow, irregular-shaped masses, of a hard and firm
character.

The third stage is the period of softening. A
tubercle never stops in the second stage ; it must ad-
vance, it must soften, it must liquify ; it becomes
resolved into a thick yellow pus, not unlike cream,
which sometimes contains more solid particles, similar
to ripe cheese, or curd : when the whole is softened, it
bursts into a neighboring bronchial tube ; it is expecto-
rated by cough, and of course leaves a cavity in the
lung, technically termed a tubercular excavation. Two,
three, or more of these tubercles, contiguous to each
other, may happen to ripen simultaneously, and run
into each other ; and thus, as their contents are ex-
pectorated, a still larger cavity is formed, which is
called a vomica. Nature will here sometimes make an
effort to repair the destruction, or at least to arrest it,
by an attempt to close and unite the opposite sides of
the excavation by a cicatrix, or scar, and thus obliter-

TUBERCLES. 11

ate the seat of decay.* But can we expect that all
will thus favorably terminate ? It is not one crop, or
one generation of tubercles that we have to encounter ;
in the same lung we may have them, at the same time,
in every stage ; and as one ripens, so will the other
advance.

To make the progress of tubercle better understood,
we will take an illustration Avhich is probably familiar
to all, namely, the glands of the neck in a person of a
scrofulous habit. We frequently see them, in children
and young people, enlarged and projecting : by bad
diet, by exposure to cold, and a thousand other causes
which will arouse the dormant disease, they become
red and tender ; they increase in size, and are in-
flamed ; presently they become softer, and fluctuate
on pressure ; afterwards they point, the skin ulcerates,
and ultimately they burst ; they then discharge their
contents, which is softened tuberculous matter, and as
the constitution improves, they gradually heal with an
irregular scar. We have all, perhaps, seen several of
these glands similarly affected, either at the same time,
or one rapidly succeeding to another, and we have
then noticed that the inflammation and the pain is not
confined to the immediate vicinity of the glands, but
that the disturbance spreads around the whole neck

* Sometimes a very considerable cavity is formed. The tubercular
matter is discharged. The substance of the lungs for a line or more
in thickness around the cavity becomes solidified. A false membrane
lines the interior. The process of disintegration is arrested. And
the individual although subject to occasional embarrassment, enjoys
a tolerable degree of health through a long life.

12 CONSUMPTION.

and to the neighboring parts. One after another,
abscesses form and burst, until pus is drip] ting from
innumerable points ; at length the whole adventitious
matter is discharged ; wide and deep openings are
left, the edges of which are hard, thick, and indolent ;
nevertheless, as the health of the patient improves, so
we may hope to close the wound, and in time it heals
by a cicatrix. Here we have the progress of scrofu-
lous tubercle in a part not essentially vital, from which
we may trace the progress of tubercle in that vital
organ, the lungs.

A tubercle, like an egg or spawn in the animal
kingdom, or a seed in the vegetable kingdom, possess-
es within itself a principle of life, which requires only
favoring circumstances to develope and mature. A
congenial soil and atmosphere is to the grain of wheat
discovered in the cerements of an Egyptian mummy,
what " a cold," " a pleurisy," is to tubercle ; wanting
this soil and this atmosphere, the grain would never
vegetate ; wanting an exciting cause, the tubercle may
remain undisturbed and unmolesting for years — for
ever : without the seed, we could not have the plant —
without tubercle, we cannot have consumption.

Because an individual has a tuberculous nucleus in
a gland of the neck, it does not follow, as an absolute
and invariable consequence, that it will undergo the
inflammation, the ripening and evacuation I have just
described : by attention to the health, by counteract-
ing every approach of disease, by removing every thing
likely to prove an exciting cause, the germ of disease

THE CAUSES OF CONSUMPTION. 13

in the neck may remain dormant for ever, or be en-
tirely removed. So it is with consumption. But let
other disease irritate the system, encourage and foster
the development of the germ in the gland, add exci-
ting causes to the latent cause, and the gland will en-
large, will inflame, and go through the stages of soften-
ing and discharging. So it is with consumption. We
may successfully prevent that which we can seldom
hope to cure.

THE CAUSES OF CONSUMPTION.

The causes of tubercular consumption come under
two classes : first, the remote, or predisposing causes ;
second, the exciting causes, or those which call the
predisposition into action.

Hereditary transmission is the chief remote cause.
It is as certain that children inherit the diseases of
their parents, as that they resemble them in feature
and in character. In proportion to the development
of the tuberculous disease in the father and mother,
will be the disposition to the same affection in the off-
spring. In some families we occasionally find the elder
children healthy, whilst the younger are born with
tuberculous disease already established, or with a pre-
disposition to acquire it, in consequence of the tubercu-
lous affection having become, in the progress of time,
and by the action of exciting causes, developed and
matured in the parent.

Any disease and any circumstance which can dete-

11 CONSUMPTION.

riorate the health of one or both parents, materially
influences the health of the child yet unborn ; thus
many persons acquire a predisposition to consumption
from their parents, although the latter may attain an
advanced age without evincing any symptoms of pul-
monary disorder.

Indigestion, some cutaneous affections, syphilis, anx-
iety, grief and the depressing passions, intemperance
or irregular mode of life in the mother, with insuffi- .
ciency of proper nourishment during pregnancy, are
all capable of inducing a scrofulous habit, and, as a
consequence, a predisposition to consumption : that
which was bad general health in one generation, is
frequently converted into tuberculous disease in the
succeeding one.

A peculiar formation of body, as distorted spine,
narrow chest, and high shoulders, must also be consid-
ered a remote cause ; and every pulmonary affection
occurring in persons thus shaped, should always be
looked upon with suspicion, even in the absence of
hereditary predisposition, or more decided exciting
cause.

The question will probably occur to many — can a
child, born of healthy parents, free from scrofulous
taint — can he in after life become affected with tuber-
culous disease ? — that is, can tubercle originate in
him ? It can. By the combination of many circum-
stances, which will be noticed under the head of ex-
citing causes, a morbid state of the system is estab-
lished, which induces and favors the depasit of tubercu-

THE CAUSES OF CONSUMPTION. 15

lous matter ; and, by the continuance of these or other
exciting causes, he may fall a victim to consumption,
and be the first of his race who has suffered by the
disease. If a child, born of robust, healthy parents,
free from .all suspicion of disease, be insufficiently or
improperly fed, or nursed by a woman whose milk is
incapable of affording a sufficient quantity of nourish-
ment, and if this child be confined in a dark, unwhole-
some apartment, wallowing in dirt and uncleanness,
tuberculous disease will, in all probability, be estab-
lished : the abdomen will become large, hard, and
tense, like a drum ; the limbs will emaciate, and the
child waste and suffer from all the symptoms of mesen-
teric disease : if the child live through infancy, in it
the germ of tubercle is deposited ; it has acquired a
scrofulous habit. This is only one of the many illus-
trations which might be cited of tubercle being origi-
nally generated.

The peculiarities of frame and appearnnc^ which
mark a scrofulous or tuberculous habit, although not
constant, are yet so characteristic of a dormant liabili-
ty to consumption, that the occurrence of what may be
an exciting cause in individuals so constituted should
be sedulously guarded against. The tuberculous dia-
thesis is usually associated with a Miiooth, fair, and
delicate skin ; a rosy countenance ; light-colored, or
reddish, fine hair ; bright blue eyes ; long eye-lashes ;
dilated pupils ; a thick upper-lip ; a narrow chest ; a
weak voice ; a slender form, with high shoulders ; the
finders slender, but the knuckles and joints large and

16 CONSUMPTION.

" clubbed ;" the veins prominent ; the teeth white
and clear ; and, in general, there is great mental sen-
sibility and constitutional irritability. It must be borne
in mind that persons who are the very opposite to this
description are not exempt from a predisposition which
may be nursed into disease. Consumptive patients
frequently have a dark complexion, and black hair.

At the risk of being tedious, I will recapitulate.
Tubercle is the seed of the disease ; it may be heredi-
tary — it may be acquired ; an individual may possess
undoubted signs of its existence — he may have the
scrofulous diathesis strongly marked — he may have
lost brothers and sisters, father and mother, by the
disease, and yet he, by preventing the germination of
this seed, may escape. It, therefore, behooves such
an one to avoid the thousand circumstances which may
act as a hot-bed in ripening this seed ; some of which
I now proceed to notice.

Exciting Causes. — Many exciting causes, when
acting together in early youth, as improper diet, im-
pure air, deficient exercise, insufficient clothing, and
the absence of cleanliness, readily become a remote
cause, capable of engendering the disease. Food which
is not sufficiently nutritious, and food that is too rich
and stimulating, are alike hurtful : the former does not
furnish an adequate supply of nutriment to support the
body in health and strength ; the latter excites and
irritates the digestive organs, and produces indiges-
tion, — one of the most frequent and active agents in
exciting consumption.

THE CAUSES OF CONSUMPTION. 17

Pure air, and plenty of it, is the basis of health : if
impure in quality, it irritates the delicate structure of
the lungs, and impedes respiration : when fresh air is
insufficient in quantity, it is unable to assimilate the
chyle, or nutritious element of food, during its circula-
tion through the lungs. A prolific source of disease is
found in the practice, too frequently unavoidable, of
many persons sleeping in the same chamber ; also in
the confinement of many persons in small, ill-ventilated
rooms, as we sometimes find in workhouses and schools,
and too frequently in factories, where, as well as breath-
ing a vitiated atmosphere, the body is restrained in one
constant and unnatural position.

A sedentary life in youth arrests the growth and
proper development of the body ; in mature age, it im-
pedes or disorders every function. Statistics clearly
prove that the disease is more prevalent in cities and
manufacturing towns than in the rural districts, where
the population has plenty of exercise in the open air ;
and tnat it is more prevalent amongst clerks, tailors,
shoemakers, and watchmakers, than it is amongst sail-
ors, cai'penters, and others whose occupation is active.
The want of exercise is an exciting cause of consump-
tion, which is constantly overlooked or misapprehended
even by the most anxious parents : under the dread of
fatiguing a delicate child, they restrict hirn^or her to
unnatural and unhealthy quietude ; and this incorrect
idea is zealously carried out at fashionable, and too
frequently finishing, boarding schools, where every
movement is regulated by rule ; and the time that

18 CONSUMPTION.

should be devoted to a skipping-rope or a foot-ball, is
sacrificed to Berlin-wool, or the forcing system of
some Dr. Blimber. Fathers should remember the
words of Rousseau, who says, " Nature intended that
children should be children before they were men. .
I would as soon require a child to be five feet
high, as to display judgment at ten." Mothers should
learn that, " Beauty, like other flowers, needs exposure
to the air and to the light of the sun." And both
should remember that —

" So wise so young, do ne'er live long."

Chilling which is insufficient to keep the body at a
proper warmth, must always favor disease, especially
pulmonary disease ; in our climate, which is so liable to
frequent and sudden vicissitudes of temperature, too
much care cannot be given to the maintenance of a
healthy and uniform warmth. The most injurious effect
of cold on the respiratory organs is when it suddenly
alternates with warmth. Fashion should be subservient
to health ; and, with some little care, the one would
lose none of its attractions, and the other would attain
continued ability for enjoyment. Nothing can be more
hazardous than the too common practice, during the
inclemency of winter, of women, who in the daytime
are clad in a Siberian costume of furs and shawls, ex-
posing themselves at night in muslin or gauze, to the
cold air of lobbies, passages, and damp pavements, im-
mediately after being heated by exercise in a crowded

THE CAUSES OF CONSUMPTION. 19

ball-room, or inhaling the warm atmosphere of a
theatre.

A constant cause of disease in females is " tight-
lacing," by which the contents of the chest and abdo-
men are compressed into a most unnaturally small
compass. The corset is a most barbarous piece of
armor, which cabins, cribs, and„ confines the feminine
proportions of women in an unnatural form, and, in
the place of natural symmetry, exhibits artificial de-
formity. Imagine the Venus de Medici reduced to a
spider waist by a pair of stays !

Personal cleanliness is a duty we owe to ourselves
and to those with whom we associate ; it is a means of
preserving health within the reach of all, and its im-
portance will be admitted when we consider that the
skin is constantly producing perspiration and unctuous
matters, which readily mix with the dust and fine par-
ticles floating in the air, and which, if allowed to collect
and remain on the surface of the body, form a coating
that closes up the pores of the skin, prevents its
healthy action, and gives to disease another ally.

Intemperance in the use of spirituous and fermented
liquors is one of the most prolific causes of consump-
tion : when acting, as too frequently happens, in con-
junction with bad, innutritious diet and insufficient
clothing, whereby the body is excited and- stimulated,
not strengthened and protected, habitual intemperance
is capable of becoming a remote cause, or the origina-
tor of tubercles, as well as the ever-ready agent to
hasten their development, should they already exist.

20 CONSUMPTION.

The blanched, emaciated countenance of the dram-
drinker faithfully corresponds with the diseased condi-
tion of his internal organs ; and it may occur that an
attack of that dreadful malady, delirium tremens, gives
more decided evidence of the mischief and destruction
effected on the nervous system. The dire effects of
this debasing habit are not confined, unfortunately, to
the drunkard himself ; his progeny suffer, perhaps, in
a still greater degree, and the frequency of tuberculous
disease in the children of dissipated parents is a fact
■which can be confirmed by every physician of experi-
ence.

Surrounded by all the temptations to err which on
every side allure the inexperience and indecision of
youth, it cannot occasion surprise that —

" Some begin life too soon, — like sailors thrown
Upon a shore where common things look strange."

Dear is the price hereafter to be paid for this pre-
cocity ; imprudence or excess may be indulged in while
strength and youth have the power to neutralize the
immediate effects of folly ; but, when these are ex-
hausted, and disease turns the balance, rapid is its
onslaught, and, it may happen, decisive the victory.

Change of temperature directly affects the respiratory
organs, and conveys an exciting cause to the very seat
of tubercle ; we, therefore, find consumption most gen-
eral and most fatal in climates that are subject to sud-
den alternations from heat to cold ; and Great Britain

THE CAUSES OF CONSUMPTION. 21

ranks the first in this unenviable position. In those
climates where the atmosphere is uniform, whether it be
cold or hot, as in Russia and the Western Indies, con-
sumption is comparatively rare ; whilst in England it car-
ries oft' about one-fourth of the inhabitants ; in Paris,
about one-fifth ; and in Vienna, one-sixth. As well as by
those rapid climatorial variations which are native to
our soil, the disease is nurtured by our own careless-
ness : this carelessness is directed rather to the effect
than to the cause, for Ave constantly meet with persons
who dread " catching cold," and use every precaution
to avoid doing so, and yet they take no heed of the
cold when it is " caught." The man who will not have
his hair cut on an inclement day, lest he " take cold,"
will, nevertheless, allow a cold and a cough to distress
him for weeks without adopting any effectual means of
removing it.

I do not remember having read a more forcible ad-
monition on the necessity of attending to "a slight
cold," than that written by the author of " The Diary
of a late Physician." The value of the advice, and
the vigor of the language, will be an adequate excuse
for the extract : — " Let not those complain of being
bitten by a reptile, which they have cherished to ma-
turity in their own bosoms, when they might have
crushed it in the egg. Now, if we call a slight cold
' the egg,' and pleurisy, inflammation of the lungs,
asthma, consumption, the venomous reptile, the matter
will be no more than correctly figured. There are
many ways in which this * egg ' may be deposited and

22 CONSUMPTION.

hatched. Going suddenly, slightly clad, from a heated
to a cold atmosphere, especially if you can contrive to
be in a state of perspiration — sitting or standing in a
draught, however slight — it is the breath of death,
reader, and laden with the vapors of the grave. Lying
in damp beds, for there his cold arms shall embrace
you ; continuing i» wet clothing, and neglecting wet
feet ; these, and a hundred others, are some of the
ways in which you may slowly, imperceptibly, but
surely, cherish the creature, that shall at last creep
inextricably inwards, and lie coiled about your vitals.
Once more, again, — again — I would say, attend to
this, all ye who think it a small matter to neglect a

SLIGHT COLD."

Mental emotion and the passions, especially those
which are depressing, exert a decided influence in
arousing tubercles from their lair. The effect of men-
tal affliction instantly overthrows the whole economy of
the system ; an agonizing sense of oppression and tight-
ness is experienced in the neighborhood of the heart
and lungs, accompanied with a dreadful feeling of
impending suffocation. If the sorrow be un-removed,
if the heart be uncheered by hope, this disturbance
continues, the health sinks under the oppression, and
the mind falls into despondency. In the downfall of
long cherished hopes ; in the bereavement of a loved
parent or friend ; in disappointed ambition ; in the
reverse of fortune ; in slighted affection ; in fact, by
all that " maketh the heart sick " — affliction of mind is

THE CAUSES OF CONSUMPTION. 23

a constant " worm i' th' bud," that preys on the health,
and accelerates the progress of consumption.

A frequent exciting cause of phthisis in young per-
sons may be traced to a deep and settled despondency,
consequent on a separation from the happy scenes and
associations of home. This has been termed home
sickness — " the piercing anguish hid in gentle heart;"
— (the heimwehr of the Germans, the maladie du
pays of the French). Whenever the sufferer from
such a cause be of frail or delicate constitution, the
danger will be greatly enhanced.

Intense application to study, which involves loss of
sensorial power and exhaustion of the nervous system,
together with sedentary habits, imperfect digestion,
and constipation, is another mode in which the mental
powers affect the health. One, from among the many
victims of consumption hastened to an untimely end by
severe mental application, was Kirke White — he who,
whilst in the grasp of the destroyer, sang, —

" Gently, most gently, on thy victim's head,
Consumption, lay thine hand ! Let me decay
Like the expiring lamp."

Rapid growth is, in many instances, the harbinger
of this disease, as it is always attended by debility in
consequence of inadequate nutrition : the progress of
development in the frame being more rapid than the
elimination of the required nourishment, the body
grows without being matured, almost without being
perfected. Richerand relates a case of this kind that

24 CONSUMPTION.

terminated fatally, the individual having grown more
than an English foot in a year.

Several occupations which produce mechanical irri-
tation of the lungs, greatly quicken the development of
tubercles : this mechanical irritation is excited by in-
haling an atmosphere loaded with minute particles of
dust or powders, as happens to sawyers, millers, starch-
makers, flax-dressers, weavers, feather-dressers, and
artizans similarly engaged. These employments, how-
ever, are harmless when compared with others in which
the dust is of a deleterious -nature, as it is in the manu-
facture of cutlery and the grinding of metals. The
mortality amongst needle, edge-tool, and gun-barrel
grinders, is excessive ; and Dr. Johnstone, of Worces-
ter, informs us that the former seldom live to be forty.
Mr. Thackerah gives a similar account of the early
fatality of such employments in Sheffield, where the
disease, so induced, is known amongst grinders by the
name of "pointers' cough," or " grinders' rot."

Sedentary employments, and confinement in a par-
ticular position, are most injurious to those who have
any predisposition to the disease : literary men, law-
yers, artists, clerks, watchmakers, jewelers, tailors,
shoemakers, and others similarly engaged, add more
than their proportionate quota to the lists of mortality
from consumption. Public speakers, clergymen, read-
ers, singers, performers on wind instruments, and oth-
ers who strain or over exert the vocal organs, are also
liable to pulmonary disease.

Some avocations appear to enjoy considerable im-

THE CAUSES OF CONSUMPTION. 25

munity from consumption ; butchers, in particular, are
seldom consumptive, and the disease is rarely found in
soap-boilers, glue-makers, fishermen, and fishwives.

Many diseases, especially those which affect the pul-
monary organs, have a peculiar tendency to excite
consumption : catarrh, bronchitis, and inflammation of
the lungs, frequently give an impulse to the more seri-
ous and fatal malady. Fever, when occurring in a
person of tuberculous constitution, acts in like manner.
The eruptive fevers, a^Lnieasles, small-pox, scarlet
fever, frequently mduSHne subsequent disorder of
the system, and in many instances that disorder is
phthisis. Nervous debility, produced by irregularity
and excess ; indigestion, which implies deficient nutri-
tion and constant irritation of the whole body, are
never-failing causes ; worms, or any thing capable of
exciting habitual irritation in any part of the alimen-
tary canal, readily induce a sympathetic action in the
lungs. The tendency of syphilis to produce consump-
tion has been noticed by almost every writer, from the
time of Bennet (1654). The remedy — the specific —
for the syphilitic poison — mercury, when used so as to
affect the system, possesses the same dangerous prop-
erty, and in persons of a delicate or scrofulous consti-
tution its employment demands the greatest caution
and circumspection. Certain profuse discharges, as
long continued diarrhoea, diabetes, menorrhagia, fluor
albus, bleeding piles, &c, may, with sufficient reason,
be included amongst the exciting causes.

The imprudent practice of young and delicate moth-

26 CONSUMPTION.

ers suckling their children, as some do, for twelve or
fourteen — nay, some eighteen months, or two years, is
most reprehensible, and dangerous, alike to themselves
and to their offspring.

It must not be supposed that these exciting causes
act injuriously in every case, or that one alone is al-
ways sufficient to foster the disease ; but we may be
assured that whatever tends to debilitate the constitu-
tion, Avhatever interfere s with t he proper nutrition of
the frame, and whatevef^B Rsses the vital powers,
will always accelerate and! H' the production of tu-
berculous disease.

The opinion at one time prevailed that consumption
was contagious ; but the experience of modern physi-
cians goes far to prove that it cannot be so propagated ;
it is, nevertheless, highly imprudent for a healthy per-
son to occupy the same bed, or to sleep in the same
chamber, with a consumptive patient.

THE INFLUENCE OF AGE ON CONSUMPTION.

Pulmonary consumption is a disease of all ages ; yet
how frequently is the poignancy of its attack tempered
by the season of its visitation. It is not the infant —
the child to whom life and its endearments, its ties of
affection, its dreams of honorable ambition, are yet
unknown or unappreciated ; it is not the decrepit man
who is steadily advancing to that bourne to which the
course of time leads us all, who is satiated alike with

TIIE INFLUENCE OF AGE ON CONSUMPTION. 27

the carc3 and the troubles, the joys and the delights of
life, — but it is youth bursting into manhood, — it is
lii.u i in the perfection of his strength, in the zenith of
his intellect, in the enjoyment of love, honor, and fame,
on whom it lays its fatal grasp. For its victims, how
frequently does it claim those to whom existence dis-
plays the brightest future of usefulness and happiness
— the young, the beautiful, the intellectual ! how fre-
quently do they hold life on its frailest tenure ! The
youth entering the busy world ; the girl gushing into
the loveliness, the tenderness of woman ; the husband
striving to maintain an infant family ; the wife cheer-
ing, encouraging and directing his efforts ; the toiler
who has just surmounted the difficulty of obtaining a
maintenance ; the aspirant within the reach of the pin-
nacle of his ambition : these, — these are the victims of
consumption.

In the chamber of the rich, surrounded by all the
comforts and luxuries that wealth can procure, that
refinement can suggest, that medical skill can direct —
in the damp, dark chamber of poverty, where the re-
quirements of sickness arc unknown, where the neces-
saries of life are stinted, consumption steadily and
surely pursues its way, and desolation of heart, of
home, of hope, follows in its path.

The period of life at which phthisis is most frequent,
has been a subject of inquiry since the earliest times.
The Greek physicians held it a common doctrine that
it rarely occurred before fifteen, or after thirty-five,
and the results of recent investigations differ but little

28 CONSUMPTION.

from this statement. Dr. Woolcombe, however, of
Plymouth, has published a table of seventy-five deaths,
ten of which took place before the age of fifteen, six-
teen between fifteen and thirty, and forty-nine above
the age of thirty. Dr. Alison, of Edinburgh, states
that fifty-five deaths occurred in the practice of the
New-town Dispensary in two years ; eight of which
occurred before fifteen years of age, thirteen between
fifteen and thirty, and thirty-four after the age of
thirty. The most satisfactory information is obtained
from the investigations of M. Louis, who gives the
following table of one hundred and twenty-three cases:

Age. Deaths

From 15 to 20 11

" 20 to 30 39

" 30 to 40 33

Age. Deaths.

From 40 to 50 23

" 50 to 60 12

" 60 to 70 5

I have now before me a list of sixty-four cases which
were under treatment in January, 1847, and I find
that,

From 12 years of age to 20, there were under treatment 14

" 20 30 24

" 30 40 12

" 40 50 10

" 50 60 4

In this number (sixty-four) three deaths occurred dur-
ing the month, at the ages of twenty-three, twenty-five,
and thirty-six.

On reviewing all the tables, we may come to the
conclusion that the development of consumption gener-

THE SYMPTOMS OF CONSUMPTION. 29

ally happens between the ages of eighteen and thirty-
five.

THE SYMPTOMS OF CONSUMPTION.

The progress of consumption is dependent on the
progress of the tuberculous deposit in the lungs;
therefore, in describing the symptoms, I shall endeavor
to place them in relation with the physical signs, or
those which may be deduced from the employment of
the stethoscope — sounding the chest, as it is popularly
termed — and thus connect the external and observable
symptoms with those changes and alterations which,
we are taught by morbid anatomy, arc going on in the
structure of the lungs.

With this view I shall consider the symptoms under
three stages, corresponding with the three periods of
tubercles already described : thus, the first stage cor-
responds with tubercles in their crude state ; the
second stage, with that of " ripening ;" and the third
and last stage corresponds with the period when they
have softened, are coughed up, and cavities or excava-
tions are formed in the lungs.

THE FIRST STAGE.

It sometimes happens that the local and functional
symptoms are so obscure or doubtful, that the existence
of consumption in the first stage of the disease cannot
be detected with certainty ; in fact, they may give so

30 CONSUMPTION.

little uneasiness or anxiety to the patient, that he may-
be unconscious of any great departure from his ordi-
nary health until the disease is far advanced, and the
case has become desperate. In other instances, the
symptoms are so prominent and so characteristic as to
attract the attention of the most careless observer.

The symptoms and signs are materially modified by
the age, strength, habits, and peculiarities of the indi-
vidual : some may be altogether absent, others may be
irregular, and all may vary in the degree of intensity.
Although the symptoms in the first stage are usually
obscure, and it is difficult to detect the real nature of
the disease, we should always suspect the presence of
consumption when we know there is hereditary predis-
position ; when we find a cough continue for some
length of time, inducing increasing debility and emaci-
ation ; and especially when the invalid bears the ap-
pearance of a scrofulous constitution.

The commencement of consumption is slow and insidi-
ous ; there is seldom any pain in the part most affected
to direct the attention of the patient to his malady.
After some slight exposure to cold, or other exciting
cause, he feels an uneasiness at the back part of the
throat, which induces a hard and dry cough : without
being very troublesome the cough continues, and is
soon accompanied by a trifling expectoration of frothy
mucus, without color and without consistence, as in
common catarrh. Presently the cough becomes more
frequent and more decided, particularly in the morning
od getting up, and at night soon after retiring to bed.

THE SYMPTOMS OF CONSUMPTION. 31

The expectoration is now transparent, but more tena-
cious, almost ropy ; any little exertion during the day,
as walking fast, or going up stairs, is sufficient to bring
on a fit of coughing, and with it quickness of breathing,
attended with some degree of oppression at the chest.
The patient soon becomes sensible of unusual languor ;
he is readily fatigued, and finds his strength unequal
to his customary labor or exercise ; he breathes with
some difficulty, and his respirations are shorter and
quicker than usual ; if he take a deep inspiration he is
conscious of uneasiness, scarcely a pain, immediately
beneath the collar bone, and this more frequently is
felt on the right side.

The local disease now begins to implicate the general
health; and, as the pulmonary symptoms advance, which
they now do more rapidly than heretofore, the whole
frame sympathizes with the chest affection. The pulse
becomes quicker than natural, especially towards even-
ing ; the body is frequently chilled with a sudden rigor,
or shivering, which is followed by increased heat of the
skin, particularly at the palms of the hands and the
soles of the feet, which, towards night, are hot, harsh,
and dry. After midnight, the feverish heat is suc-
ceeded by a moisture ; and, towards morning, the body
is bathed in a profuse perspiration : the sleep is oc-
casionally disturbed by a sharp attack of coughing, and
the patient arises in the morning, relaxed and enfee-
bled.

The appearance of the invalid soon attracts the atten-
tion of his friends ; the countenance loses its healthy,

32 CONSUMPTION.

rosy bloom, and at one time is pale and anxious, and
again suddenly flushed with a blush of red ; the eyes
sparkle with unusual brilliancy ; the hair grows long
and damp ; the body diminishes in bulk, and begins
gradually to waste ; the flesh loses its natural firm-
ness, and is soft and loose ; the spirits are dejected ;
the appetite precarious, and he is indolent, languid,
and easily fatigued.

The patient may continue for a considerable length
of time in the state just described ; he may gain re-
newed strength to combat the exhausting effects of his
disease ; the further development of tubercles may be
retarded by judicious remedial measures ; the growth
of this, the first crop, may be arrested, and he may be
restored to such a share of health as to remove the
alarm of his connections. But, alas ! " the snake is
scotched, not killed." By some accession of cold, the
symptoms again return ; again they may be subdued ;
and, thus battling with disease, life may be prolonged
for years after the known and certain existence of that
which at one time or other may prove fatal. Dr.
Latham relates that he knew one patient in this state
twelve — and another, twenty years.*

* Frequently early in the disease, almost always towards the close,
the tubercular affection involves the larynx, or organ of voice. The
voice is more or less affected, sometimes entirely lost. When it occurs
early, before the symptoms of affection of the lungs are distinctly de-
clared, it often occasions a delusive hope that this is all, and the atten-
tion is entirely turned in this direction. A distinction here is important.
If the symptoms are owing to a simple inflammatory affection, although
they may be obstinate in their resistance, they are eventually very

THE SYMPTOMS OF CONSUMPTION. 33

In other instances — rapid decline — the disease is
not so controllable ; it assumes the mastery at the on-
set, maintains it, and conquers.

Before detailing the physical signs, it may not be
irrelevant to give a short account of the stethoscope,
an instrument which is as essential to the physician as
is the compass to the navigator.

The stethoscope was invented in the year 1816 by
Laennec, a French physician. It is generally made of
cedar wood, of a cylindrical form, about ten inches
long, about an inch broad, having a cylindrical perfora-
tion throughout its whole length, an expansion or cup
at one end, and a flat surface at the other ; in effect, it
is a wooden tube. Its use is to convey the sound
emitted in the chest to the car, and enable us to prac-
tice mediate auscultation — that, is, listening to the
sounds and movements of the heart, lungs, &c. We
all know that when a person has a cold, and the bron-
chial tubes are loaded with mucus, the air rushing
through them gives rise to a wheezing in the chest, or
a rattle in the throat ; and if we apply the ear to the
side of a person, we may hear the heart beat. It was
left to Laennec to notice, and to turn to practical ac-
count, the indications thus afforded of the actual state

sure to yield to treatment. If they are owing to tubercle, they almost
as certainly go on to a fatal termination. These two classes of the
affection usually go with the public, improperly, under the name of
bronchitis and are often uselessly very harshly treated, when a careful
and intelligent observation of the symptoms would show that the affec-
tion of the larynx is only one feature of a much more grave disease
elsewhere.

34 CONSUMPTION.

of the working machinery of our internal organs. At
the time of his discovery he was physician to the
Necker Hospital, in Paris, and in its wards he insti-
tuted a series of observations and experiments, first to
ascertain the regular and healthy sounds which were
elicited in natural, vigorous respiration and inspiration,
and afterwards those alterations and changes which
were caused by disease. The result of his experiments
was, to use his own words, " a set of new signs of
diseases of the chest, for the most part simple, promi-
nent, and certain, and calculated, perhaps, to render
the diagnosis of these diseases as positive and circum-
stantial as that of many affections which come within
the immediate reach of the hand or instruments of the
surgeon."

One of the first physicians who introduced the ste-
thoscope into England, was my late respected teacher,
Dr. Thomas Davies, who was the friend and pupil of
Laennec during the time he was perfecting his dis-
covery. Dr. Davies, on his return from Paris, where
he paid much attention to the nature and treatment of
pulmonary and heart affections, opened a class at his
own private residence, which was attended by many
practitioners in the metropolis, and from that period
the value of the stethoscope has neither been doubted
nor neglected.

The Physical Signs are obscure when the tubercles
are small in size and few in number, and scattered
throughout the substance of the lungs ; when, how-
ever, many are accumulated together, and we apply

THE SYMPTOMS OF CONSUMPTION. 35

the ear to the chest whilst the patient is speaking, -\ve
shall find, at that particular part where they are situ-
ated, that the voice resounds in an unnatural manner,
because the solid substance of the tubercles is a better
medium for the conveyance of sound than the elastic
structure of healthy lung. Wherever, therefore, the
patient's voice can be most distinctly heard, there may
we suspect the presence of tubercles. We may also
detect an inequality in the sound of the respiration.
At one part of the lung it may be soft and easy ; at
another part, where tubercles oifer an obstruction, it
will be found irregular and interrupted. By observing
the motions of the chest during inspiration, we may
sometimes discover one side more fully expanded than
the other ; and, when this happens, we may suspect the
existence of tubercles on that side which is the more
contracted.

THE SECOND STAGE.

The symptoms now cannot be mistaken ; whatever
was doubtful in the first stage, is confirmed into a sad
reality.

The cough, which before was only occasional, is now
frequent and distressing ; the expectoration is no longer
a scanty, clear, frothy mucus, but is copious, and as-
sumes a purulent, or muco-purulent character, which
presents, on examination at different periods, some or
all of the following appearances :— It is opaque, thick,
and of a pale yellow color ; sometimes it has a greenish

36 CONSUMPTION.

tint, and at others, it is dark, almost black : a portion
may acquire a greater, even hard consistence, and be
surrounded by a watery or whey-like mucus ; it may
be tinged with blood, or contain small specs or streaks
of blood ; small solid particles, or shreds, resembling
curd, of a dead white, or straw color, varying in size,
from a pin's head to a grain of rice, may be noticed
floating or sustained, either in a cream-like, or a trans-
parent fluid ; sometimes the softened tubercles are
coughed up in flakes. The expectoration, in some
cases, is devoid of smell ; in others, it has a faint foetid
odour ; it is of greater specific gravity than water, and,
when deposited in a vessel containing that fluid, mixes
with it, or sinks to the bottom.

The cough, although constantly tormenting the pa-
tient, is seldom attended with any acute pain, except
when there is some slight degree of inflammation of the
pleura (the investing membrane of the lungs, and the
lining membrane of the chest), or when old adhesions
of the two pleuroe — the result of former inflammation —
interfere with the natural expansion of the lungs. Pain,
almost of rheumatic character — indeed, it is sometimes
referred to rheumatism alone — is frequently experi-
enced around the shoulders, between the shoulder-blades,
and at one or both sides ; occasionally, there is diffi-
culty in lying in bed on one or the other side, without
some pain and uneasiness. In general, the amount of
pain endured during the progress of the disease, bears
no proportion to the extent of mischief going on in the
lungs.

TIIK SYMPTOMS OF CONSUMPTION. 37

The difficulty of breathing, which in the first stage
was temporary, is now, in the majority of cases, con-
stant. This may be readily accounted for by the
increased size and increasing number of the tubercles
having encroached upon, and blocked up, the air cells,
and thus diminished that surface of the lungs by which
the act of breathing is performed. In some instances,
the patient complains of very little annoyance in respi-
ration, and when tranquil he breathes with ease and
freedom ; nevertheless, any considerable or long-con-
tinued exertion cannot be borne without much tightness
and oppression of the chest, and mounting an ascent
always aggravates the dyspnoea.

Hectic Fever. — When the expectoration is puru-
lent, and presents the characters I have just described,
that condition of the system which is designated hectic
fever, always prevails ; at the very commencement of
consumption this fever slowly and insidiously affects the
health and strength, but it is seldom that it manifests
itself in all its fearful symptoms until the tubercles be-
gin to liquify and pus is formed.

Hectic fever is of a remittent type, and is said to
have two accessions in the twenty-four hours ; on s in
the middle of the day, and the other towards evening ;
with the exception of the evening exacerbation, which
is always regular, the periodicity of its return is uncer-
tain ; sometimes it is absent altogether during the day,
and sometimes the patient is never free for any length
of time from its sudden invasion ; but these repeated

38 CONSUMPTION.

attacks are never so severe as that which exhausts the
patient in the evening and night.

The access of the fever commences with chills and
shuddering, and a sense of "creeping" in different
parts of the body ; the back, especially down the course
of the spine, although hot to the touch, feels cold to the
patient, and he is acutely sensible of the slightest
breath of cold air. After a time, varying from half-an-
hour to two or three hours, the hot stage succeeds, and
the patient is then burnt up with fever — he is restless,
and overpowered with lassitude ; the pulse is seldom
less than 100 — more frequently 120 ; the skin is hot
and dry, and the face is flushed and burning. This
stage lasts several hours, and towards morning termi-
nates in perspiration.

The ordinary acceptation of the word " perspiration,"
is quite inadequate to express the amount of the night
sweats ; the body is not bedewed, or damp, but wet ;
perspiration, like drops of water, oozes from the pores
of the skin, and in some instances rolls from the body
almost in a stream, so that towards morning, the per-
sonal clothing and bed-linen are completely saturated
with moisture. The chest in particular is subject to
this excessive perspiration ; and in cases where the
disease presents itself without any aggravated symp-
toms, the patient constantly complains of awaking with
his breast and shoulders damp and moist. Of all the
signs diagnostic of consumption, not one is so constant,
or so confirmatory of the disease, as these night sweats.
When hectic fever is established, the pulse increases

TIIE SYMPTOMS OP CONSUMPTION. 39

in rapidity, and beats from 100 to 120 or 130 ; the
heart palpitates violently, and is easily excited by
trifling causes ; the respiration is hurried; the cough
is "hacking" and exhausting; the body loses flesh,
and wastes or melts away; the flesh that remains is
soft and flabby, and the skin loses every appearance of
health. The debility is great, and the lassitude so in-
creases that the patient is quite unequal to any bodily
exertion. The sleep is invariably disturbed by repeated
paroxysms of cough, induced by the loaded state of the
air-passages ; and the least change of position, as turn-
ing from one side to the other, is sufficient to cause a
recurrence of the attack. The appetite is fickle ; some-
times it remains good to the last, but more frequently
there is perfect loathing of food, which occasionally
produces nausea and vomiting : thirst is seldom
troublesome or excessive, even during the feverish
state. The tongue often preserves a healthy appear-
ance for some time, but afterwards it becomes dry, of
a deep red color, and at its edges and tip is frequently
covered with small ulcers, resembling particles of cur-
dled milk : this aphthous state of the tongue may
extend to the throat, and cause numerous small sores,
which distress the patient, and render swallowing pain-
ful. At the commencement, the bowels are usually
constipated ; after a time they become irregular, being
relaxed for several days, and again costive : when, as
niav happen towards the close of the disease, the mu-
cous membrane of the bowels is irritated, or even ulcer-
ated, diarrhoea is frequently present, and greatly assists

40 CONSUMPTION.

to reduce still lower the remaining strength of the pa-
tient. The urine is generally high-colored, inconstant
in quantity, and deposits a bran-like sediment.

Haemoptysis, or spitting of blood, generally becomes
an alarming symptom at this stage of the disease, and
by presenting to the patient visible evidence of the ex-
istence of internal mischief, frequently arouses the first
suspicion in his mind that he bears within him the germ
of a fearful complaint.

The ordinary phrase, rupture of a blood-vessel, is not
always a correct one ; when a blood-vessel is si rup-
tured" — I am speaking now without reference to
external violence — it is usually caused by a morbid
distension of the blood-vessels and increased impetus of
the blood, and is technically termed an active hemor-
rhage. Active hemorrhage more frequently occurs in
those vessels which are the least protected and sup-
ported by integuments, or by surrounding muscular or
ligamentous substance ; thus the minute vessels which
supply the Schneiderian membrane of the nostrils are,
in some persons, liable to be ruptured by any trifling
exertion, as sneezing, or by a slight blow. Active
bleeding of the lungs is usually accompanied by symp-
toms denoting determination of blood to that organ, or
by actual inflammation, rather than by those symptoms
of diminished action which we usually find in this stage
of the disease.

When the whole system is debilitated, as it is in con-
sumption, the blood-vessels are of course in a weakened
condition ; their coats become lax, they lose their natu-

THE SYMPTOMS OF CONSUMPTION. 41

ral patency, and, "without being ruptured or their con-
tinuity interfered with, they allow the red particles of
blood to exude and become effused. This is termed
passive hemorrhage, and is the cause of spitting of
blood that we have now to encounter. This degree of
hemorrhage will continue without any marked increase
of the other pulmonary symptoms, or the invasion of
new ones : the expectoration is dotted with small par-
ticles of congealed blood, and occasionally streaked
with a delicate film of a bright red color ; sometimes
pure blood is coughed up, or discharged without an
effort, and the quantity may vary from a drop to a tea-
spoonful, and from that to a much larger quantity ; but
it seldom escapes in a stream, as it will do in active
hemorrhage.

As the disease advances, the bleeding may arise
from active and passive hemorrhage, inasmuch as the
branches of some arteries may be ruptured by the sof-
tening of the tubercles ; and the weakened coats of
others may allow the constant oozing or weeping of

blood.

The periodical indisposition in females is either
irregular, deficient, or altogether absent; and this
deviation from custom, is often erroneously considered
as the cause of all the debility, languor, and wasting,
instead of the effect of the pulmonary disease.

The appearance of a patient advanced to this stage
of decline is so characteristic of the disease, that to
those who have experience in its treatment, the coun-
tenance and figure depict, almost describe in detail,

42 CONSUMPTION.

every symptom. The account given by Areteeus so
faithfully portrays this appearance, that I cannot do
better than borrow a sentence from the elegant trans-
lation of the late Dr. Young. " The nose becomes
thin, especially at its point ; the cheek bones project —
the skin covering them is pale during the day, in the
evening it is flushed in circumscribed patches of a
brilliant red color — (hectic blush) ; the white part of
the eye shines, and is of a light pearly hue ; the eyes
are large and bright, although somewhat sunk in their
orbits ; the cheeks are hollowed ; the lips retracted,
presenting often the appearance of a melancholy smile ;
the teeth increase in transparency ; the whole body is
shriveled ; the spine projects, instead of sinking, from
the decay of the muscles ; the shoulder-blades stand
out like the wings of a bird ; the fingers are shrunk,
except at the joints, which are prominent ; the nails
are curved ; and the hairs gradually fall from the
head."

During this wreck of health, the mental faculties
continue perfect, and are often endowed with increased
intelligence ; the temper may be occasionally irritable,
but the spirits are seldom oppressed on account of the
malady. Hope, a strong hope of ultimate recovery,
constantly and wonderfully sustains the patient ; he
will admit he has " a cough which may be serious ;"
but " when warm weather comes he will be better."
How often have I heard a girl, who could scarcely
utter the word — " Wonder why mamma was fretting ?"

»
THE SYMPTOMS OF CONSUMPTION. 43

— unconscious that the danger which surrounded her-
self was the sole cause of a mother's sorrow.

The duration of the second stage of consumption is
variable : in some cases a few weeks may be sufficient
to place the patient beyond hope ; and he is then, in
familiar language, said to be in a " galloping consump-
tion ;" while others may continue for months, or even
years, without any aggravation of the symptoms, or
much increase of the disease taking place. By main- •
taining the general health, and supporting the strength,
Ave may arrest the further development of more recent
tubercles, and those which have already advanced to
" softenmg," may be reduced to a chronic state ; or —
but avc must confess the instances are rare — the scat
of softened tubercle may become obliterated by a cura-
tive process, which unites the sides of the cavity.
When, hoAvever, spitting of blood, diarrhoea, and night
SAveats, reduce and Avaste the patient, the result is
rapid, although the disorganization of the lungs may
have ceased.

The physical signs iioav indicate more clearly the
change and enlargement which the tubercles have un-
dergone, and, by a careful examination of the chest,
Ave may gain positive evidence of the internal mischief.
The sound of the voice, Avherever an enlarged tubercle,
or a mass of tubercles exist, is louder than elsewhere,
and gives rise to the stcthoscopic sound, termed bron-
chopliony : bronchophony, however, by itself, should not
lie considered a certain diagnostic of tubercle, unless
conjoined with a dull sound on percussing the part sus-

44 CONSUMPTION.

pected with the points of the fingers. On applying the
stethoscope, we sometimes hear a distinct crepitation
or crackling, and occasionally, at the upper part; oi' the
lung, we hear a still louder sound, like a gurgling.

The sounds are at first more distinctly heard at the
upper part of the chest, and gradually proceed down-
wards ; they are often more decided on one side than
the other, according to the extent of tuberculous de-
posit in the lungs.

THE THIRD STAGE.

This stage of consumption coincides with the com-
plete softening of the tubercles, when the liquified tu-
berculous matter bursts into the bronchial tubes, is
then gradually expectorated, and the seat of the abscess
converted into an excavation or cavity.

The symptoms described as characteristic of the
second stage, now prevail in "greater intensity; the
cough is scarcely absent for any length of time, but
tears and racks the breast, sides, and back, with sharp,
lancinating pains, and leaves the patient, after each
paroxysm, faint and exhausted : during the night the
cough is unceasing, and drives off that natural and
blessed restorative — sleep. At the commencement of
a paroxysm, the cough is " hollow," but as the expec-
toration becomes loosened, it gives a gurgling or rolling
sound, which gently subsides almost to a murmur. The
expectoration is profuse, occasionally amounting to a
pint in a few hours : it consists of a heavy, purulent

TIIR SYMPTOMS OF CONSUMPTION. 45

discharge, in consistence equal to cream, and in color
varying from pale yellow to green, or bluish-black or
brown ; it contains small lumps of a curd-like substance,
and is sometimes freely mixed with fresh florid blood ;
at others, the blood is in minute congealed clots or
threads ; the odor is generally faint and sickly, in
some cases foetid and offensive. The expectoration
may be so copious in quantity, and the strength of the
patient so prostrated, as to deprive him of ability to
eject or cough up the accumulated matters, and thus
suffocation may be threatened. I remember a case
that occurred at the London-hospital, during the time
I was dresser, in which death was instantaneous from
these causes.

Spitting of blood does not happen so frequently in
this, as in the earlier stages of the disease ; the tuber-
culous matter, in its softened state, appears to throw
aside the larger blood vessels, and in examinations we
sometimes find them flattened, and occasionally oblit-
erated ; but, except in their most minute ramifications,
seldom ruptured.

The breathing is oppressive and difficult ; the
dyspnoea does not come on in occasional or spasmodic
attacks, but is constantly laborious, in consequence of
the imperfect inflation of the lungs — perhaps I should
say, of what remains of the lungs : the least exertion,
or change of position, aggravates the oppression, and
the sufferer obtains breath by a succession of gasps,
rather than by natural respiration.

The hectic fever ravages the frame with undimin-

46 CONSUMPTION.

ished violence ; the chills are frequent ; the succeeding
heat produces an exhausting faintness, and the perspi-
rations during the day, as well as the night sweats, are
abundant. Diarrhoea is generally present, and the
copious evacuations which are constantly occurring,
reduce the strength of the patient to the lowest possible
ebb, and constantly cause an overpowering sensation
of faintness and sinking. The appetite is bad ; and it
is only by the most savory, delicate, and not always
the most proper food, that the patient can be tempted
to eat. Whatever is eaten readily causes uneasiness
and disturbance in the stomach ; sometimes it is quickly
rejected ; but, if retained, it creates so much irritation
as to produce pain and nausea. Flatulence, and vio-
lent eructations of acid, unpleasant wind, constantly
harass the patient, and occasion a " rising in the
throat," which appears to threaten suffocation. The
pulse maintains its unnatural rapidity, and is seldom
less than 110 ; the surface of the body is always hot
to the touch, and the palms of the hands and the soles
of the feet are burning. The throat and mouth are
generally sore from numerous small aphthous ulcers,
and in some cases the larynx is ulcerated : when this
occurs, it renders the cough still more frequent and
painfully distressing. I have, in several instances,
noticed the formation of small abscesses, either in the
rectum, or in the immediate neighborhood of the lower
gut, during the last stage of consumption ; indeed, the
whole mucous membranes appear to approach closely
to ulceration, if they are not absolutely ulcerated.

THE SYMPTOMS OF CONSUMPTION. 47

Towards evening the feet and ankles become swollen,
tumid, and filled with fluid, and drops) in various forms
may make its appearance : sometimes the limbs are
anasarcous, at others the abdomen is tumid, or the
chest fluctuating. When dropsy becomes general, as
is sometimes the case, the night sweats and the
diarrhoea cease : within a few days, however, the per-
spiration may return, and then the infiltration subsides,
so that one set of symptoms alternates with the other.

With these symptoms the emaciation and debility
keep pace ; the strength is barely sufficient to support
the limbs, and the frame is reduced to that of a skel-
eton ; the cheek bones become more prominent, and
the cheeks still thinner ; the lips are retracted, and the
countenance yet maintains a melancholy or bitter
smile ; the neck appears elongated, and sometimes
hangs listlessly on one or other side ; the shoulder-blades
are elevated, and the chest contracted; the ribs may
be easily counted, and the spaces between each are
deep ; the joints are large and protuberant ; the nails
grow rapidly, and become more incurvated, almost like
talons ; the hair is clamp, weak, and continually fall-
ing. The voice, when the larynx is ulcerated, is
hoarse, and attended Avith a clanging sound ; some-
times it is shrill and hollow, and at others the patient
can scarcely speak louder than a whisper.

Whilst the physical powers of life are thus decaying,
the mind holds its pre-eminence unimpaired ; the
faculties are acute, and, strange as it may appear, are
capable of the higheflk cultivation, and even of abstruse

48 CONSUMPTION.

study. I attended during the last year a youth, who,
in the progress of his malady, acquired a perfect knowl-
edge of the German language, and trained his mind by
a severe study of mathematics, with the hope — the
abiding hope, that in a life yet to be prolonged, he
would reap the benefit of his application. I had a pa-
tient, a young lady, who, not forgetful of devotional
reading, was deeply engaged in perusing " The Hunch-
back of Notre Dame," on the day of her death.

To the last moment she still clings to hope ; she is
unconscious of any inward emotion that tells her her
disease is fatal; she views the despondency of her
friends with surprise, almost with peevishness, and is
ever buoyed up with the faith, almost the certainty, of
her recovery.

In other cases, but they prove the exception rather
than the rule, the mind is comparatively torpid ; the
patient is indifferent to a return of health, or to a fa-
tal issue ; and in some cases an excited delirium attends
the last days of life.

Although the course of the last stage of consumption
is characterized, in a large majority of cases, by the
symptoms I have now detailed, yet, in some instances,
there may be a total cessation of those prominent and
peculiar signs which belong alone to the close of this
devastating disease ; thus, we may occasionally see
cases in which the cough, the expectoration, the diar-
rhoea, the exhausting perspirations, cease altogether,
and leave the patient in a state of happy and placid
tranquillity. When this occurj,.it must be attributed

THE SYMPTOMS OF CONSUMPTION. 49

more to the failure of the animal powers, and deficien-
cy of material, than to any permanent restoration of
the system ; for at last the scene closes, by life gently
gliding away, " like the expiring lamp," in ease, in
peace — and, may we always be enabled to say, still in
Hope !

The physical signs at this stage are decided. The
formation of the chest is altered ; the shoulders are
elevated and dragged forward, and the capacity of the
chest is narrowed. During respiration, the collar
bones and the first two or three ribs are immovable,
and when the patient attempts to take a full inspira-
tion, the upper part of the thorax appears to be forci-
bly drawn upwards, instead of expanding with that
spontaneous case which attends health. Percussion —
that i.s, sharply, but delicately, tapping the sides of the
chest with the points of the fingers — gives a dull sound
at the upper part of the chest ; but, if applied over the
seat of a cavity, it is loud, and, when the patient is
much emaciated, it may be heard acute or hollow. By
the stethoscope we discover several sounds, according
to the state and size of the vomicce. When the tuber-
culous mass softens, and is partially expectorated, the
voice is heard in that part of the chest, and the sign
is known by the term pectoriloquy ; the natural mur-
mur of respiration at and around the seat of the tuber-
culous abscess is indistinctly heard, and in some parts
is inaudible ; in that part of the lungs which still re-
mains healthy, it is particularly clear and distinct.
When the patient coughs, we hear a gurgling sound,

5

50 CONSUMPTION.

and the voice resounds in different parts, particularly
at the back, near the shoulder-blades. If the excava-
tion be large, we then discover, when the patient
coughs, or breathes, a peculiar metallic tinkling, which
is a kind of silvery-ringing sound, closely resembling
'that emitted by a cup of metal, glass, or porcelain,
when struck gently with a pin, or into which a grain of
sand has been let fall : this sign denotes the presence
of air within a large preternatural cavity. A modifi-
cation of this sound, named by Laennec, amphoric re-
sonance, or buzzing, is sometimes heard ; it resembles
the sound produced by blowing quickly and forcibly
into an empty bottle having a narrow aperture.

Tuberculous Consumption, of whatever degree,
must depend upon a corresponding anatomical change
of structure, or disorganization of the lungs : this
change of structure may vary remarkably in the tardi-
ness and rapidity of its progress ; in one case advancing
with uncontrollable speed ; in another, delayed for a
lengthened period ; so that the disease may appear as
two different affections, rather than modifications of one
and the same disorder. Hence, consumption, in pop-
ular phrase, is called a " galloping consumption," " a
rapid decline," or Acute Consumption. When its
course is slow — " a lingering consumption," or Chronic
Consumption.

ACUTE CONSUMPTION. 51

ACUTE, OR RAPID CONSUMPTION.

The duration of this form of the disease varies from
a few months to two years ; sometimes it runs its
course in two or three months, or, as in the case of
the Duchess de Pienne, recorded by M. Portal, in ten
or twelve days. M. Andral has related the history of
four cases, the duration of which varied from twenty-
one to thirty-five days.

When the disease travels to the fatal goal with such
prodigious rapidity, it occurs in those in whom the
hereditary predisposition is great, and whose habits
and idiosyncrasies greatly favor the perfect develop-
ment of the tuberculous matter. In such cases, all
the symptoms I have before recited, are present in an
unusual degree of severity, and succeed to each other
with great rapidity. The cough becomes day by day
more distressing and exhausting, and the expectoration,
at first mucus, quickly becomes purulent, curd-like,
and tinged with blood. The hectic fever is violent,
the perspiration constant, and the diarrhoea seldom ab-
sent ; the emaciation of the body is excessive, the
whole frame is in a state of decay, and readily preys
upon itself.

In other instances, in young and delicate persons,
more frequently females than males, the symptoms are
so trifling, that the real condition of the patient often
escapes the observation of herself or her friends, until
the lungs are tuberculous to a considerable extent ;

5 2 CONSUMPTION.

nevertheless, the signs are so characteristic of the dis-
ease, as to disclose to the observant physician the
amount of mischief of which they arc the unobtrusive,
but significant, heralds. In such cases, Ave find debili-
ty the most prominent symptom.

I am frequently consulted by the friends of young
and enfeebled girls, who are said to have been delicate
from their infancy, who take cold on the least exposure,
and have been " short-breathed " for many years. On
inquiry, I find they have a slight cough, with some lit-
tle expectoration, but it is so common, or so constant,
that "really, they think the cough of no consequence:"
there is no pain in the chest, no spitting of blood ; the
spirits are exuberant, and the imagination ardent.
Presently, on some fresh exposure to cold, the cough
becomes more troublesome, the expectoration more co-
pious, and, on one or two occasions, has been seen
tinged with blood; the breathing is now more op-
pressed, the languor increases, and the skin is drenched
with moisture. To those who have daily presented to
them such cases, the countenance tells its own history,
and that is comprised in one word — consumption. The
cheeks are generally of a leaden or faded hue, except
when lighted up with a transient hectic blush, and the
lips are of a bluish color ; the white of the eye has a
peculiar dull, pearly tint, and the whole features are
shrunken. When thus affected, the patient may sink
with great rapidity ; an attack of diarrhoea may speed-
ily waste away her strength ; or, after some trifling ex-

CHRONIC CONSUMPTION. 53

ertion, a fainting fit may suddenly supervene, and as
suddenly prove fatal.

Of all the forms of consumption, this is the most in-
sidious, the most treacherous, as the actual amount of
danger is never suspected by the friends of the patient,
because of the absence of the more decided local symp-
toms, and their obscure character when they do exist.
In consequence of the individual being always in a state
of sickly health, easily fatigued by exercise, and op-
pressed by a high, and chilled by a cold temperature,
many anxious mothers have allowed this fatal disease
to make irremedial progress, in the belief that her child
was delicate, but not consumptive.

CHRONIC CONSUMPTION.

Bayle and Laennec were the first who described the
nature of protracted cases, and proved their identity
with tubercles. Hoffman relates the history of three
persons who lived under the disease for thirty-six
years. In 1828, a person, named Robert Jeffries, died
in the Fleet-prison, aged fifty-six years ; he had had
cough and shortness of breath for thirty years ; on ex-
amination, after death, his lungs were found filled with
tubercles and abscesses. In the " Edinburgh Commu-
nications " is detailed the case of a man, who passed
nearly the whole of a long life with tubercles in his
lun^s ; he was consumptive from eighteen to seventy-
.two, and at last died of the disease.

B*

54 CONSUMPTION.

The chronic form occurs at a more advanced period
of life, in persons in whom the hereditary predisposi-
tion is not strong, and who have been placed in circum-
stances which do not favor the development of disease,
or have delayed its advancement by precaution and
care.

The symptoms are, in certain stages, obscure, and
seldom referred by the patient to the lungs ; the gen-
eral health is greatly impaired ; there is considerable
languor, debility, and disinclination for exertion ; the
appetite is good, and there is no pain ; but there is a
slight cough, with some little expectoration, and, de-
spite the good appetite, the patient loses both strength
and flesh. On the return of winter, the cough is more
troublesome, and is accompanied with some expectora-
tion ; he is susceptible of cold, and seriously affected
by every change of temperature ; he still loses bulk,
and is languid. As the succeeding summer advances,
his health improves, and any occasional discomfort he
may experience he then refers to the stomach. To-
wards the following winter, however, the disease as-
sumes a more formidable aspect ; the cough becomes
constant, and is attended with a free expectoration ; he
perspires with the least exertion, his breathing is op-
pressed, and he daily finds himself unable to undergo
that fatigue which previously afforded no inconvenience.
Such cases are very common amongst the middle and
higher classes of society, who are able to desist from
labor or excitement so soon as they are affected by any
serious amount of illness ; so that by care, and by

DURATION OF CONSUMPTION-. 55

avoiding fresh exposure to cold, the disease, in its full
violence, may be protracted from year to year.
Amongst the working classes and lower orders, whose
necessities compel them at all hazards to continue their
daily pursuits, one or two winters often bring the dis-
ease to its almost inevitable conclusion.

Chronic consumption is seldom a source of much
anxiety to the patient or his connections, inasmuch as
they are ignorant of the malady ; the cough is little
heeded, because it does not increase rapidly in severi-
ty, and may be entirely absent during the summer ; as
well as this, the subjects of the chronic disease are
generally those who are considered delicate or ailing,
so that the pulmonary symptoms creep on quietly, and
are overlooked, or attributed to debility, cold or dys-
pepsia — in fact, to every cause but the right one.
When, however, the symptoms become so urgent — the
cough constant, breathing difficult, expectoration copi-
ous, perspirations profuse — as clearly to point to the
lungs as the seat of the disease, the patient is even
then more inclined to think he has acquired a new dis-
order, than that lie is suffering an aggravation of his
former complaint.

From what I have stated, it will be seen that the
duration of consumption is influenced by many causes,
and that it may be a disease of weeks, or of years.
The mean duration, as calculated from the tables of
Bayle and Louis, is twenty months ; in a record of one
hundred and sixty-two fatal cases, I find that more
than one half terminated in nine months.

5G CONSUMPTION.

The man whose position enables him to avoid expo-
sure to sudden changes of the weather, who has proper
diet and proper clothing, who has at his command
means to combat the symptoms of the disease as they
arise, has a far better chance of withstanding its effects
and arresting its progress, than he who has none of
these auxiliaries to assist him. The tuberculous disease
may be controlled by remedial means, and by improv-
ing the general health ; and thus an individual may
continue for years alternating between disease and
health.

The seasons of the year also exert a powerful influ-
ence ; if the disease has shown itself early in the winter,
the symptoms may be checked or arrested during the
coming summer; if, on the other hand, it appears in
the summer, or early in the autumn, the coming winter
may bring it to a more speedy climax. From the
tables of Dr. Heberden, we find that the maximum
of deaths occurs in March, February, December, Jan-
uary, April, and May ; and the minimum in November,
June, July, September, and August : this result ac-
cords with the prevalent opinion, that the disease
proves more fatal in the winter and spring.

Is consumption curable ? In answering this question
I shall take for my text the words of Sir James Clark.
He says : " It is only by convincing the public of the
comparative futility of all attempts to cure consump-
tion, and of the signal efficacy of proper measures to
prevent it, that physicians can ever hope to produce
those beneficial results in improving public health, and

DURATION OF CONSUMPTION. 57

in preserving and prolonging human life, which is the
distinguishing privilege of their profession to aim at."

It may be considered an opprobrium to- the medical
profession ; but, nevertheless, every honest physician
must admit, that all attempts to cure tuberculous con-
sumption have hitherto failed. To reply to the anxious
inquiry of a father, or a husband, that consumption is
curable, would be " a delusion, a mockery, and a
snare ;" and the man who would presume to say this,
can only be considered " a boasting charlatan."

If every disorder of the lungs, whether arising from
catarrh, bronchitis, or dyspeptic consumption, be called,
as they are by some irregular practitioners, consump-
tion, then I, also, will admit the disease to be curable ;
but, up to this period, tuberculous consumption has
never been permanently cured. " As well might we
attempt to restore vision when the organization of the
eye is destroyed, or the functions of the brain, when
the substance of that organ is reduced by disease to a
pultaceous mass, as to cure a patient whose lungs are
extensively disorganized by tubercles."

Although compelled to admit that the disease is sel-
dom, if ever, curable, still it is allowed me to say, that
it may be so palliated, its progress may be so retarded,
and its consequences so counteracted, that a long life
of utility, of happiness, and of comparative health, may
be reserved for those who adopt such means and pre-
cautions as art is able to suggest. The disease may be
made to accomplish its course by " parts and parcels,
many times beginning, many times apparently ending."

58 CONSUMPTION.

"We may shelter the vessel, but we cannot restore
the -wreck.

THE TREATMENT OF CONSUMPTION.

I hold the opinion that consumption is a disease of
debility ; a disease of imperfect nutrition, and of exces-
sive irritability of the nervous system ; having for its
result tuberculous deposits : that the inflammation and
fever by -which it is frequently attended, are merely
concurrent circumstances, to some extent independent
of tubercles. I consider that the especial aim of all
treatment should be to induce such a change of system,
such a change of habit or constitution, as may retard
the progress of the tuberculous deposits, and prevent
the formation of succeeding crops of tubercles.

I, therefore, maintain that the most rational plan of
treatment must be based on the endeavor to re-invis-
orate the whole frame ; to supply proper nutriment
according to the capability of the digestive organs ; and
to soothe and tranquilize the nervous irritation.

We know that latent consumption quickly becomes
active consumption when the body is debilitated, and
whenever any of the numerous exciting causes impede
healthful circulation, digestion, and nutrition ; there-
fore, the first indication is to remove such exciting
causes as may exist, and to restore, as far as possible,
the healthy functions of the various organs of the body.
Without the general health be improved", how tempo-
rary will be the palliation of any single symptom.

THE TREATMENT OF . CONSUMPTION. 59

In speaking of the treatment of consumption, I
intend to pass unnoticed the ridiculous theories, and
less than theories, the ridiculous fancies of many clever,
but sanguine physicians, and the nostrums of rapacious
and ignorant empirics. I shall not describe how one
advised a diet of snails, how another relied on a resi-
dence in coal-mines, how another depended on earth
baths, another on the exhalations from cow-dung, and
another on my inhaling apparatus, and my chlorine or
iodine gas ; but shall confine myself to that rational
mode of management which perfect knowledge of the
disease, judgment, and candor, must dictate to those
who care to think, and which my own experience and
daily practice has proved to be beneficial.

I propose to consider, first, the general management
of consumptive patients ; secondly, the treatment of
each symptom, as cough, dyspnoea, spitting of blood,
hectic fever, &C. ; and, thirdly, the prophylactic treat-
ment, or the means of prevention.

THE GENERAL MANAGEMENT OF CONSUMPTION.

It is seldom that an individual is brought under the
notice of the physician, as a patient, at the very com-
mencement of the tuberculous disease ; it is not untd
the cough, or pain in the side, compel him to seek ad-
vice that he considers himself an invalid ; and then
how frequently is he merely treated for these symptoms
„,- tl disease, whilst the disease itself is forgotten or un-
heeded ; and how frequently might these symptoms, at

60

CONSUMPTION.

their first appearance, be restrained by means the very
opposite to those which are employed when they be-
come more developed ;— in other words, how frequently
would the elimination and circulation of good, nutritive
blood prevent the abstraction of a poor, worthless, san-
guineous fluid, when inflammation has succeeded to
irritation. If we could arrive at the earliest indica-
tions of consumptive disease, we should find, in nine-
teen cases out of twenty, that debility and irritability
are the avant couriers. How, then, should these de-
rangements of the health be treated ? Certainly not
by the lancet ; not by digitalis ; not by antimony : and
yet, when the debility and irritability have produced a
consequent fever, and an accelerated— not vigorous—
pulse, and the patient is submitted secundum artem U>
modern practice, the fever is allayed, the pulse dimin-
ished, by bleeding and by digitalis ; and, in the pros-
tration of the patient, the fever is supposed to be
checked, and the heart's action subdued.

It is my opinion, not heedlessly avowed, that these
symptoms may be more safely removed by manufactur-
ing in the system an increased quantity of pure and
healthy blood, than by the abstraction of what little
blood— good or impoverished— there may be.

_ I have no hesitation in saying, that the lancet and
digitalis have hastened the progress of tuberculous
disease in numberless cases; that they have arrested
it in none.

A person affected with tubercles is liable to inflam-
mation of the lungs, or of the pleura, perhaps, in a

THE TREATMENT OF CONSUMPTION. 61

greater degree than another ; and when inflammation
docs occur, the loss of blood, either by the lancet, by
cupping, or by leeches, may be indispensable ; but it
should be abstracted with caution, and not one drop
withdrawn more than is sufficient to remove the ur-
gency of the pneumonia, or the pleurisy.

I speak thus strongly against the too common prac-
tice of indiscriminate bleeding in consumption, because
I have daily to witness the direful effects it is capable
of inducing ; I have been consulted by patients who,
to use their own words, " have been bled like calves ;"
I know the eagerness with which any heroic plan of
treatment is sought for by the consumptive and the
friends of the consumptive ; and I would impressively
caution them against the, not heroic, but " fool-hardy "
remedy, that S' mighty instrument of little men," the
lancet.

Believing consumption to be a disease of debility,
how are we to give strength to the patient, without pro-
ducing over excitement ? By proper diet, pure air,
exercise, clothing, and cleanliness.

Proper diet is the key-stone of all treatment ; by it
Ave may correct or modify the constitutional disorder,
as well as support the patient with that strength which
he requires to contend against its exhausting effects.
In the following remarks I can only give general hints,
which must bo adapted to the varying circumstances of
each individual case.

The diet should be nourishing, without being stimu
lating : a moderate quantity of animal food may be

6

62 CONSUMPTION.

allowed daily, but only of those meats that are easily
digested, and are not rich and gross in their nature.
Mutton is by far the best ; beef may be occasionally
substituted — veal or pork, never. Veal, as commonly
cooked, is unsuited to the consumptive or dyspeptic
patient ; but when deprived of its fibrine, as it is in jel-
lies, it is wholesome and nourishing. White poultry,
as chickens, turkeys, rabbits, and pigeons, are not im-
proper ; on the other hand, water-birds, as ducks and
geese, are indigestible, and to be avoided. Game is
nutritive, and easily dissolved in the stomach, especi-
ally venison, grouse, and partridges. Of all the pro-
cesses of cooking, broiling is the best ; and a chop or
steak thus prepared affords more nutriment in a small
compass than any other kind of food. Roast meat is
more nutritious than that which is boiled : the assertion
may startle some persons, but I am convinced that
those " animo-vegeto decoctions," called broths and
soups, are unwholesome ; they load the stomach with
an useless mass, and satisfy hunger, certainly ; but the
nourishment they afford is trifling, whilst the flatulence,
distension, and indigestion, are abundant.

Fish yields little nutriment, and is not so easily di-
gested as is generally imagined ; whitings, soles, floun-
ders, trout, and oysters, only, may be eaten with
prudence. Cooked vegetables should be used moder-
ately ; asparagus, French beans, spinach, and turnips,
are the best. Raw vegetables, as water-cress and
lettuces, taken in moderation, are grateful, and not
injurious ; cucumbers, onions, celery, and radishes,

TIIK TREATMENT OF CONSUMPTION. 68

should be shunned as poison. Milk, from its bland,
unirritating, and nourishing properties, is most valu-
able, and has always been held in high estimation in
phthisis ; it should, however, be used more sparingly
than is usually the custom. The milk of asses is supe-
rior to cow's milk, as it contains less caseous or cheesy
matter, is lighter, and equally nutritive : mare's milk
is superior to either, but few patients can overcome a
natural dislike to its use. The ordinary beverages,
tea and coffee, are not the most proper fluids for the
consumptive patient. Tea is without one particle of
nutriment ; it favors perspiration, relaxes the mem-
branes of the stomach, and induces nervous wakeful-
ness ; coffee is nutritious to a certain extent, but it is
also exciting, and should not be employed when there
is the least tendency to spitting of blood, or inflamma-
tion. The Italian chocolate is nourishing, without
being stimulating, is speedily and easily digested, and
frequently improves the appetite for solid food. The
" soluble cocoa " of commerce is too much adulterated
for the invalid ; when obtained pure, or when made
from the " nibs," cocoa is excellent. A coffee, pre-
pared by Messrs. Hurford and Co. from the dandelion
root, has deservedly obtained some fame for its medici-
nal and agreeable properties ; whenever the action of
the liver or kidneys is impaired, or when there is any
irritability of the stomach, it is a valuable substitute
for the usual beverage drank at the morning meal.

A moderate quantity of wine may be allowed, or, in
its absence, some good malt liquor ; and the bitter pale

64 CONSUMPTION.

ale of Allsop or Bass, is preferable to all others. An
occasional beverage may be obtained from a thin jelly
of Iceland moss, or linseed tea, slightly acidulated with
lemon juice. The less quantity of fluid that the patient
takes, the better ; it should be sipped, rather than
taken at " hearty draughts," and the temperature
should never exceed that of new milk.

I will now sketch a day's diet on the plan I uphold.
Breakfast, at eight o'clock : — A large cup of pure
chocolate, or half-a-pint of new milk, with dried toast,
or water biscuits, and the yolk of an egg lightly boiled ;
or a basin of thick porridge, made of Scotch oatmeal.
Luncheon, at eleven : — A glass of good Madeira, or
something less than half-a-pint of pale ale, and a bis-
cuit. Dinner, at two : — A broiled mutton chop, broiled
or roasted chicken, or a cut from a hot joint of roasted
beef or mutton, toasted bread, a glass of Madeira
diluted with water. Tea at six : — A cup of black tea,
with little sugar, dried toast or biscuit. Supper, at
nine : — A biscuit and orange marmalade, or cold boiled
rice with preserved fruit, or a few raisins with bread
and milk. Bed, at ten.

Now, although I advocate this generous diet in cases
where inflammation is absent, and the patient has incli-
nation for such food, I wish not to be considered as
treating consumption on the " beef-steak-and-porter "
system, so properly derided by Sir James Clark ; we
may over-stimulate a patient by food, as readily as we
may exhaust him by the lancet ; there is safety only in
a happy medium. I have constantly under my notice

THE TREATMENT OF CONSUMPTION. 65

cases in which a weak, rapid pulse, ranging from 120
to 140, has been reduced twenty or thirty beats, by
supplying a deficiency of good blood ; proving that the
irritability of the heart and arteries is proportionate to
this deficiency.

Much mischief is incurred by immuring the con-
sumptive in heated chambers, and preventing them
inhaling the pure, unadulterated breath of Heaven : a
consumptive patient should almost live in the open air
when the state of the atmosphere is mild, dry, equable,
and congenial to his feelings. In England, Under-
cliflfe, in the Isle of AVight, Torquay, Hastings, Pen-
zance, and, in the neighborhood of the metropolis,
lirompton, Hampstead, and Hornsey, are peculiarly
eligible, and when the circumstances of the patient
permit, a residence during the winter at one of these
places, or in a climate where this inclement season is
less subject to vicissitudes, is of the highest importance.
The late Dr. Young observed, that the mean tempera-
ture, from October to March, was, from the year 1790
to 1794, as follows: — At London, 43 degrees; at
Penzance, 48 degrees ; Lisbon, 55 degrees ; Madeira,
63 degrees. In this point of view, Madeira, therefore,
is the most healthy locality.

Exercise should be taken daily, either by walking,
riding on horseback, or sailing ; a long journey, by
such easy stages as will not fatigue the patient, has
frequently arrested the progress of the disease. Rid-
ing on horseback is of infinite service, and when it can
be accomplished, ought never to be neglected. A sea

66 CONSUMPTION.

voyage, or a short excursion along the coast, has, in
many instances known to me, removed all the urgent
symptoms, and the invalid has returned as with a new
lease of life. Certain gymnastic exercises, when not
too violent, frequently assist to give energy and vigor
to the system ; when the strength of the patient will
not permit any great exertion, swinging in the open air
is a healthful, soothing recreation.

The clothing should be warm and sufficient, without
being relaxing, and so regulated as to preserve the
surface of the body, in every change of weather, and
of the seasons, at an equal temperature. As a general
rule, I am opposed to the wearing of flannel next the
skin ; it absorbs the perspiration, becomes damp, and
does not readily part with the moisture by evaporation ;
it retains all the unctuous secretions constantly exuding
from the body ; in many instances it creates that de-
gree of heat which is too relaxing, and it always tends
to diminish that hardihood of constitution which is the
best preventive of disease. As well as for these
reasons, it is objectionable on the score of cleanliness ;
where can be the luxury of putting on a clean linen or
calico shirt over a soiled flannel ? If the additional
warmth which flannel certainly imparts be required, let
it be worn — but not next the skin. The best material
for underclothing is calico ; it maintains an equal
warmth, better than any other fabric ; it allows the
perspiration to escape by evaporation, and never clings
to the body, coldly and damp, as does linen. The pa-
tient should never sleep in the same clothing that he
has worn during the day.

MEDICAL TREATMENT. 67

Water is one of the best prophylactics of disease
that beneficent Nature has provided for us, and in the
malady now under consideration, when judiciously em-
ployed, is of considerable utility. The cold bath should
seldom be resorted to, as we cannot insure that re-ac-
tion, or slow, which follows its use in perfect health : a
tepid bath, at about 76 or 80 degrees, will frequently
tranquilize the system, and procure for the patient a
good night's rest, when all other means fail. When a
bath cannot be procured conveniently, the invalid
should dash his chest night and morning with tepid
water, and afterwards use a moderately coarse towel,
so as to excite some slight degree of friction.

MEDICAL TREATMENT.

The medicinal auxiliaries that assist in correcting the
system and ameliorating the constitutional disorder, are
tonics and sedatives.

The vegetable tonics that unite a bitter with an
astringent principle, as the infusions of gentian, casca-
rilla, quassia, are of great utility, and may be taken
daily, concurrently with other remedies for the peculiar
symptoms of the disease, except when there is inflam-
mation of the lungs or pleura. The grateful aromatic
bitter of gentian, when combined, as it is in the infusion
of the London Pharmacopoeia, with orange-peel, forms
an agreeable and refreshing draught, and affords an
innocent stimulus, without the risk of producing over-

68

CONSUMPTION.

excitement or irritation : a wine-glassful may be taken
two or three times during the day. Cascarilla is well
adapted to cases in which the function of the stomach
is disordered. The powder or decoction of cinchona
bark, seldom agrees with consumptive patients, whilst
its active principle, quinine, is free from all objection,
in cases in which this vegetable is indicated. Several
of the mosses, especially Iceland moss, are held, and
deservedly so, in high estimation, for, with an aliment
of considerable nutrition, they possess a tonic power,
that, far from increasing vascular action, seems rather
to quiet it. The bitter principle of Iceland moss closely
resembles the medicinal qualities of the hop, which is
both sedative and tonic*

The mineral tonics, as iron, copper, &c, should be
prescribed with much caution, as they are apt to pro-
duce too great excitement, and add to any degree of
fever that may be present. That elegant preparation,
the citrate of iron, is the best mode in which feruginous
medicines may be administered; the compound iron

* Within a few years cod liver oil has acquired considerable reputa-
tion as an alleviate of some of the symptoms, if not as a curative of
the disease. Its degree or mode of operation has not yet been satisfac-
torily decided. That in many cases which are not too far advanced, it
for a time improves the appetite and increases the flesh cannot 'be
doubted. This temporary effect it produces apparently in many
chronic affections. Whether it has any further effect in any disease, or
any specific effect in consumption, will depend upon a larger and more
thorough experience than it has yet received ; as there is no reason to
suppose that it ever has any mischievous effect, and as there is suffi-
cient evidence of a certain degree of efficacy, it should at present be
held prominently forward as one of the remedies to be tried ; probably
promising as much, if not more, than any other.

MEDICAL TREATMENT. 69

mixture of the London College, is far less objectionable
than the popular tincture of steel, which is the ordinary
panacea of amateur prescribers.

I place much confidence in the acids which may be
regarded in the joint character of sedatives, refrige-
rants, and astringent tonics. The mineral acids are
more commonly prescribed, but from their corrosive
quality, I think they cannot be thrown in sufficient
abundance into the circulating fluids ; on this account I
prefer the vegetable acids. Acetous acid diminishes
action generally, but gives tone to the system ; it
checks night sweats, restrains hemoptysis, but produces
cosfivcness ; if we guard against this evil, it may be
administered with manifest and unmixed advantage. It
may be given in doses of two or three drachms in a
wineglassful of infusion of cascarilla and a little syrup,
three or four times a day. I have, in numerous cases,
been enabled to trace increased energy in the system,
cessation of the night-sweats, and improved appetite, to
the administration of the following : —

Take— Sulphate of quinine, 20 grains ;

Strong acetic acid (Beaufoy's), 2 drachms;

Tincture of hops, 3 drachms ;

Tincture of squills, 3 drachms. — Mix.
Dose, thirty drops, in a little water, three times a day.

I have repeatedly prescribed citrate and tartaric acid,
but never with any good effect.

The elixir of vitriol, or diluted sulphuric acid, is a
favorite tonic in domestic medicine, and is one that may
be employed, in moderate doses, with safety. We

70 CONSUMPTION.

should never deride those simple remedies which havo
acquired fame amongst the people ; for we may be as-
sured that their popularity has been gained by their
proved utility : at the same time we must recollect that
tampering with medicine is frequently more hurtful
than allowing disease to progress unnoticed.

As the general health improves by careful regimen
and mildly tonic treatment, we may confidently antici-
pate a diminution, if not the entire removal, of that
irritability of the system which hurries on the progress
of tubercle, and, by preventing the patient taking pro-
per nourishment, induces that wasting fever peculiar to
the disease. Should, however, the nervous irritability
remain unsubdued, it will be necessary to have re-
course to medicines possessing sedative properties ; as
hop, lettuce, hyosciamus, aconite, morphia, prussic
acid, &c. Of these, the extracts of hop and of lettuce
are the safest and best ; they exert a balmy influence
over the whole frame, allay the cough, and do not pro-
duce that loathing of food common to more active seda-
tives and narcotics. Hyosciamus is a valuable remedy
for the same purpose, but is apt to disturb the stomach
and bowels ; when employed, the tincture is the pref-
erable preparation, as its strength is generally uniform,
whereas the extract cannot be depended on, as scarcely
two chemists prepare it in the same manner: the tinc-
ture may be given in doses of ten or fifteen drops, in
some bitter infusion, twice or three times a-day, fol-
lowed by a full dose of thirty drops at bed-time. Prus-
sic acid, or the acidum hydrocyanicum dilutum, is,

MEDICAL TREATMENT. 71

when prescribed with caution, a safe and useful seda-
tive. Opium, and the preparations of opium, as the
acetate and muriate of morphia, should not be used
until other sedatives have failed ; opium, by itself, is
highly improper, as it may cause congestion, and inva-
riably induces headache, constipation, and some degree
of fever.

Cough. — In the earliest stage of the disease the
cough is seldom very troublesome, and is caused rather
by a sensation of tickling at the back part of the throat,
than by any accumulation of mucus in the windpipe or
larger bronchial tubes : considerable relief may be ob-
tained in such cases from the use of any bland demul-
cent which will lubricate the mouth and fauces. A
mucilage of gum-arabic, the refined extract of liquorice,
linseed-tea, black currant jelly, are safe and proper
domestic remedies ; or, the following agreeable medi-
cine may be taken with considerable advantage: —

"Pake— Emulsion of sweet almonds, 5 1-2 ounces ;

Oxymel of squills, half an ounce.— Mix.
A tablespoonful to be taken occasionally.

In a few instances, however, can we expect to re-
strain the cough in this comparatively quiescent state
for any length of time; too frequently it becomes
rapidly constant and distressing.

I would here earnestly express my disapprobation of
the too common practice of obtaining temporary relief
from opium. This drug is certainly one of the most
effectual and valuable drugs we possess, but it is one
that quickly loses its power of doing good in innocent

72 CONSUMPTION.

doses ; so that the quantity necessary to produce the
wished-for effect, must be daily augmented, until it be-
comes no longer innocent. Opium, and its prepara-
tions, laudanum, paregoric, and morphia, should always
be used sparingly, and deferred, if possible, to a late
period of the disease, in order that the patient may ob-
tain the greater benefit when its aid is most required.
I may add, by way of parenthesis, that opium is the
basis of all the "quack" advertised nostrums for
cough, asthma, and consumption ; the increasing sup-
ply which the system demands when once habituated
to its use, is not the least favorable point to those mer-
cenary speculators, who make the health of their fellow-
creatures the object of commercial enterprise.

It is a fact well known to medical practitioners — and
patients soon discover it also — that the effect of any
remedy is diminished by the frequency of taking it ; so
that that formula which gave ease to-day, -will be with-
out avail this day week. It is, therefore, advantageous
to vary the form, and even the" ingredients, of our
remedies. I subjoin one or two prescriptions for
" cough mixtures," which may be persisted in for a
time, and then, one exchanged for the other : —

Take — Tincture of hops, 4 drachms ;

Syrup of red poppies, 3 drachms ;

Diluted sulphuric acid, 1 drachm ;

Mucilage of gum arabic, 2 ounces. — Mix.
Two teaspoonsful to be taken every three or four hours.

Or,-

Take — Syrup of squills,

Syrup of white poppies,

Spirit of sweet nitre.— Of each equal parts.
A teaspoonful to be taken three or four times a day, in water.

MEDICAL TREATMENT. 73

Or-

Take — Emulsion of sweet almonds, 7 ounces ;

Tincture of hops, 4 drachms ;

Syrup of the balsam of tolu, 4 drachms ;

Oil of aniseed, 15 drops. — Mix.
A large spoonful to be taken every three or four hours.

When the cough is so frequent during the night as
to deprive the patient of sleep, it will then be necessary
to employ a narcotic, and morphia is the best : it is
always prudent to commence with the smallest possible
dose, for as the disease advances, it is generally neces-
sary to increase the quantity ; and in the latter stages
it often becomes the chief solace of the patient amid
his multiplied sufferings. A pill, prepared as follows,
may be taken a short time before going to bed : —

Take — Muriate of morphia, 1 grain ;

Ipecacuan powder, 6 grains ;

Extract of gentian, sufficient to form six pills.
One to be taken for a dose.

The extracts of conium, hyosciamus, and belladonna,
may be occasionally substituted, when the effect of the
morphia, in its minimum dose, begins to diminish : bel-
ladonna must be prescribed with the greatest caution ;
the dose should never exceed the eighth, or, at the
most, the sixth part of a grain.

When the cough is aggravated by an accumulation
of mucus in the bronchial tubes, and when there is
much difficulty in expectorating, we must endeavor to
assist nature by the exhibition of some gentle expec-
torant medicine, such as the following : —

74 CONSUMPTION.

Take — Ipecacuan wine, 3 drachms ;

Tincture of squills, 4 drachms ;
Acetous acid, 5 drachms. — Mix.

A teaspoonful to be taken for a dose, in linseed tea.

Or,-

Take — Decoction of Senega root, 8 ounces ;
Tincture of squills, 2 drachms. — Mix.

Two tablespoonsful to be taken occasionally.

I object to the indiscriminate employment of anti-
mony, as an expectorant, in consumption : if there be
inflammation, then antimony may be ordered with
safety and advantage. In the absence of inflammatory
action, it creates a long continuing nausea, and de-
presses the powers of the patient more than the urgency
of the bronchial obstruction demands ; and as other
remedies, free from this objection, are capable of pro-
ducing all the good we crave for — antimony possessing
no specific curative property — I never prescribe this
drug when other remedies will equally fulfill the pur-
pose.

When the tubercles begin to soften, the patient is
sometimes unable to expectorate without violent exer-
tion, and consequent straining and exhaustion. In
such cases the difficulty in breathing is so great, that
we are compelled to resort to means more speedy in
their action than the ordinary expectorants. A gentle
emetic will frequently spare the patient many hours'
harassing cough, and procure for him a good night's
rest: even in the last stage of consumption I have
never noticed the administration of emetics followed by

MEDICAL TREATMENT. 75

other than a good effect, for the expectoration i3
brought up almost without an effort, and thus the re-
maining strength is treasured. The metallic emetics
are admirably adapted to our purpose, as they excite
vomiting immediately, without the previous nausea and
depression which ipecacuanha and antimony produce ;
their action is quick, and they do not debilitate the
stomach, or create pain or tenderness. An emetic
composed of from ten to twenty grains of the sulphate
of zinc, or six to twelve grains of the sulphate of cop-
per, will speedily cause the discharge of a quantity of
sputa, which the strength of the patient could not, per-
haps, spontaneously expectorate.

With the vain hope of subduing local irritation,
improving the secretions from the lungs, and allaying
the consumptive cough, the inhaktion of various gases,
medicated air, and fumigation, has, from time to time,
occupied the attention of physicians. I have watched
many cases in which iodine, chlorine, the vapor of tar,
and benzoin, were inhaled — the benefit supposed to be
derived was always doubtful ; in some instances the
injury was positive : the only gas fit for the lungs is
that of a pure, warm atmosphere. Sir James Clark,
who must ever be considered one of the best authori-
ties on this disease, says, " When more correct views
of the nature of consumption arc generally entertained,
we shall no longer hear it asserted that the disease is
to be cured by inhalation, or any other local means ; "
and I believe this remark coincides with the opinion of
every candid physician. Directed by the relief which

76 CONSUMPTION.

a patient always experiences from a moist, warm atmos-
phere, we may successfully imitate this, when the air
of the chamber is so dry as to excite an irritating
cough, by placing a basin of boiling water near the pa-
tient ; the vapor thus diffuses itself in the air of the
chamber, and renders it more soothing to the irritated
surfaces of the air passages, while it spares him the
irksome labor of inhaling through expensive tubes and
spouts.

Dyspncea. — In the first stage of consumption diffi-
cult breathing does not occasion much distress ; the
respiration, however, in the latter stages, is oppressed,
laborious, and painful. When the dyspnoea occurs in
paroxysms, after a fit of coughing or extra exertion,
twenty or thirty drops of sulphuric aether, in a small
quantity of camphor mixture, will often prove useful.
This form of consumptive dyspnoea was described by
Laennec as a besoin de respirer, or an increased want
of breath, for which he prescribed the extracts of bella-
donna, conium, and stramonium : the latter, in small
doses, to the extent of a quarter or half a grain during
the day, is an excellent remedy.

When the breathing is constantly difficult, external
applications are sometimes beneficial ; a blister, or a
mustard poultice, should be frequently applied to the
chest, and if the oppression be very severe we may
apply the mustard to the arms or calves of the legs at
the same time. The dyspncea may be occasioned by
congestion of the pulmonary blood-vessels ; when the
pulse is quick, full, and bounding, and we are satisfied

MEDICAL TREATMENT. 77

that the lungs are congested, it "will then be prudent to
abstract a small quantity of blood from the arm. When
the bronchial tubes are filled with an accumulation of
mucus, or when the stomach is overloaded with an
undigested or improper food, an emetic will frequently
afford immediate relief and remove the oppression at
the chest.

Pain at the Side is seldom a very urgent symp-
tom, unless there be inflammation of the lungs, or of
the pleura. If the pain be acute, but transitory,
amounting only to a " stitch " in the side, dry cupping
is often serviceable, and if this be followed by the
application of a blister, the benefit is more decided and
permanent. Many persons suffer considerable irrita-
tion and disturbance of the whole frame during the
" rising" of a blister: a mustard poultice is free from
this objection, and is a convenient, efficacious, and
ready substitute. Friction, with some stimulating or
anodyne embrocation, as soap liniment and strong
spirits of ammonia, or soap liniment and laudanum,
frequently affords immediate relief. If the pain be
slight, but constant and fixed to one particular part of
the chest, a slightly stimulating plaster, containing a
portion of Burgundy pitch, may be applied to the seat
of the pain.

Spitting Blood. — In active hremoptysis, while the
blood is actually flowing, the first thing to be done is
to keep the patient perfectly quiet ; he should be pre-
vented making the slightest movement, even speaking
must be forbidden ; fresh air must be freely admitted,

78

CONSUMPTION.

so that he inhale a pure, cool, and unirritating atmos-
phere. When the pulse indicates increased action of
the heart, or there is sanguineous congestion of the
lungs, we must not delay, even whilst the patient is
expectorating blood, in opening a vein in the arm, and
abstracting such a quantity of blood — regulated by the
urgency of the symptoms, the constitution, and strength
of the patient — as will diminish the pulmonary circula-
tion. In bleeding under such circumstances, it is
better to take away at first a sufficient quantity of
blood to arrest the hemorrhage, rather than do so
timidly and sparingly. Paradoxical as it may appear,
we must depend on loss of blood from the general cir-
culation, as the chief means of checking its flow in the
chest. Local depletion, as by leeches or by cupping,
is of doubtful utility ; sometimes it is not free from
danger, as it may produce the evil it is intended to
prevent or remove.

It commonly happens, in the course of a few hours
after the hemorrhage has ceased, that feverish symp-
toms come on : the pulse becomes full and hard, the
skin hot, and there is a sense of oppression about the
chest. In order to prevent the repetition of blood-
letting, the treatment must be guarded and active : a
saline purgative should be immediately given ; saline
antimonial medicines frequently administered, and the
patient kept low, cool, and quiet. Cold, even iced,
acidulated drinks, as lemonade, tamarind-water, apple-
tea, &c, alone are to be permitted, and food of all

MEDICAL TREATMENT. 79

kind prohibited, until the threatened inflammation is
entirely subdued.

In passive haemoptysis, when the blood passes from
the vessels to the lungs, as it were by exhalation, and
in quantity scarcely more than sufficient to tinge the
expectoration, bleeding is seldom required : acid and
astringent medicines, in conjunction with a low, veget-
able diet, and perfect repose, are in the majority of
cases sufficient to restrain the hemorrhage. Sulphuric
acid, in the proportion of ten or fifteen minims of dilute
acid, to an ounce of the compound infusion of roses,
may be administered every two or three hours ; and,
when this is not sufficiently energetic, we must have
recourse to alum, or the di-acetate of lead. Some of
the preparations of iron, as the citrate or the compound
iron mixture, of the London Pharmacopoeia, are valua-
ble medicines when the haemoptysis proceeds from
debility.

In both forms of haemoptysis, the most perfect repose
is essential to safety ; the patient should scarcely be
permitted to move hand or foot until the bleeding is
entirely checked ; he must be sustained by cold, acid-
ulated beverages ; his chamber kept perfectly cool, and
his bed sparingly covered with clothing.

As may be easily supposed, an invalid, after spitting
any quantity of blood, is frequently in a state of alarm
and nervous irritation ; when such is the case, it will
bo proper to add twenty or thirty drops of tincture of
hyosciamus to the acid draught, until the excitement is
alloyed.

80 CONSUMPTION.

Inflammation of the Lungs is the most adverse
complication of consumption, as' the means we are com-
pelled to employ are directed to lowering the strengtk
and power of the invalid : bleeding is indispensable, and
bleeding to such an extent as will produce some effect
on the system, as faintness, or sickness, diminution of
pain, and reduction of the strength of arterial contrac-
tion. When the loss of blood is imperative, the patient
should be in the upright position at the time it is ab-
stracted, and it should flow from a large orifice in the
arm ; for by this method a greater impression is made
upon the inflammatory disease, and a cure can be thus
effected by a less loss of the vital fluid than if a larger
quantity be taken away in a small and slow-flowing
stream. If the weakness of the system contra-indi-
cates general blood-letting, local bleeding, either by
cupping glasses, or by leeches, is to be preferred.
Blisters are unquestionably of the greatest importance,
if prescribed with judgment : physicians seem now to
agree that until the heat of the skin diminishes, and
the pulse becomes less frequent and full, they should
not be applied ; for so long as the inflammatory fever
exists, they add to it, by the constitutional irritation
which they produce. On the continent the free exhi-
bition of tartarized antimony has many partisans.
Laennec esteemed it the first remedy ; his plan was to
administer a solution of one grain of tartarized antimony
every two hours, repeating the dose six times : after
this, if the symptoms were not urgent, and the patient
disposed to sleep, he allowed him to remain quiet for

MEDICAL TREATMENT. 81

six or eight hours ; hut, if the oppression at the chest
was great, or the head was affected, he directed the
medicine to he continued, the dose being then in-
creased to a grain and a-half, or two grains, or even
two grains and a-half. In England this plan has not
yet gained many advocates : the want of success which
has attended its extensive employment, may, I think,
be attributed to the amount of stomach disturbance,
with which inflammation of the lungs is generally com-
plicated in our climate. During the winter 1846-47, I
gave the antimonial treatment a fair trial, and the re-
sult was far from satisfactory ; certainly we cannot
depend upon it alone.

The bowels should be kept in a moderately relaxed
state by neutral salts or by an enema ; violent purga-
tives are most hurtful. Refrigerant medicines are of
the greatest service ; one of the most common and
useful is nitre, which may be combined with the citrate
of potash, or made to produce a more certain determi-
nation to the skin, by the addition of camphor, or anti-
monial wine, or by a combination with the citrate or
acetate of ammonia. Fifteen grains of the nitrate of
potash, a drachm of syrup of lemons, and a wine-glass-
ful of water, forms an agreeable and useful draught,
which may be taken every three or four hours.

I need scarcely add, that the patient must be sus-
tained by the lightest and coolest diet; acidulated
barley-water, tapioca, and arrow-root, in small quantity,
being the only articles approaching to food that can be
permitted : the chamber must be kept of an equable

82 CONSUMPTION.

temperature, and the risk of any sudden draught care-
fully avoided.

Pleurisy must be treated in the same manner as
inflammation of the substance of the lung : bleeding,
blisters, laxatives, counter-irritants, and low diet, are
the remedies upon which we must depend for subduing
the inflammatory action ; as well as ati'ecting this, we
have also to guard against the frequent, I might almost
add, the constant, result of pleurisy, namely, the effu-
sion of fluid, or coagulable lymph, in or between the
two pleurae, which rapidly becomes organized, and con-
verted into cellular bands of variable length, connect-
ing or gluing the two pleurae together, so as to prevent
all lateral movement between them, and thus obliterat-
ing the pleural space. To prevent this effusion, and to
cause its absorption when effused, we must trust to
blue-pill, or calomel ; small doses of the latter, from
one to three grains, should be ordered every three or
four hours, and if it passes off too freely by the bowels,
it must be combined with opium.

Hectic Fever. — The cure of hectic fever must be
dependent on the cure or removal of the disease by
which it is caused ; if it is sympathetic with an abscess
in a joint, as " white swelling " of the knee, all the
constitutional irritability and fever ceases so soon as
the disease in the limb, or the limb itself, is removed :
in the hectic of consumption, we can only palliate and
do little more than attack symptoms as they arise ; our
chief aim being to lessen the irritable diathesis, and to

MEDICAL TREATMENT. 83

strengthen the frame, -without stimulating or increasing
the force of the circulation.

The most eligible means of subduing the irritability
of the system, are afforded by the medicinal acids,
which, as I have before said, act not only as sedatives
and tonics, but they also abate the febrile heat, dimin-
ish restlessness, and frequently succeed in checking
the perspirations. The light bitter infusions are proper
vehicles for their exhibition, and when the acetic acid
or lemon-juice is employed, a wine-glassful of the infu-
sion of cascarilla, quassia, or columbo, may be agreea-
bly acidulated and taken several times a day. When-
ever diarrhoea is present, acids of all kinds must be
immediately discontinued.

It is seldom that bark can be administered without a
risk of inducing an increase of fever, as well as annoy-
ance to the stomach. The Angustura bark generally
agrees better than the Cinchona ; to the former myrrh
and iron may, in some cases, be added with advantage,
particularly as they are united in the mistura ferri
composite) or " Griffith's Mixture." Quinine in small
doses, as in the formula, page 52, may be adventured
with caution.

When necessary, the bowels must be acted upon by
gentle laxatives, as the neutral salts, the confection of
senna, or other mild aperients. A relaxed state of the
bowels — in fact, an exhausting diarrhoea — frequently
supervenes in the latter stages of consumption, and
frustrates all our attempts to strengthen the patient ;
when excessive, it must be quickly controlled by medi-

84 CONSUMPTION.

cines, and decoction of logwood, or chalk mixture, com-
bined -with some light aromatic, or catechu, are well
adapted for the purpose.

In many instances, there is a constant sickness : I
attended a lady some years since, who, for several
months, rejected every particle of solid food as soon as
swallowed ; the stomach being so irritable, that it was
only by the daily use of prussic acid that fluid nourish-
ment could be retained. Lime water, taken with an
equal quantity of milk, will frequently allay the nausea;
soda water, or Seltzer water, may be ordered with the
same intent.

During the hot stage of hectic, the patient will de-
rive great relief from sponging the hands and feet with
tepid or cold vinegar and water, and afterwards care-
fully drying away the moisture. The cold stage may
be mitigated in severity by keeping the patient in bed,
warmly covered, until the time of the anticipated attack
has passed.

The copious night-sweats constitute one of the chief
sources of discomfort, and all remedial means are fre-
quently powerless in restraining them : the acids only
are to be relied on, and of these we are constantly de-
prived by the occurrence of diarrhoea. Great benefit
will be derived from sponging the chest and shoulders
with tepid vinegar and water before retiring to rest ;
and I consider it indispensable that the night clothing
should be of calico. Immediately on awakening in the
morning the night-dress should be changed, and the
body carefully rubbed with a soft, warm towel.

MEDICAL TREATMENT. 85

The diet should be light, yet nutritive, taken in
moderate quantities, and at long intervals, as some
increase of the fever is^ always produced by the process
of digestion. When the appetite for animal food con-
tinues, which is not often the case, it should be in-
dulged in with the greatest moderation, and only such
meats allowed, as by past experience are known to
agree with the stomach. Mutton, game, or chickens,
cooked in the most simple manner, may be eaten in
small quantities once a day. Light puddings, prepared
of rice, tapioca, white bread, or arrow-root, with a
plentiful supply of milk or whey, are, in a majority of
cases, the only suitable diet. Fish, salted meats,
cooked vegetables, pastry, and condiments are decided-
ly hurtful : lettuce is an excellent sedative, and con-
joined, as it generally is, with vinegar, is a grateful
and proper esculent. Wine can seldom be permitted ;
if, however, no great increase of pulse is induced by a
small quantity of sherry, plentifully diluted with water,
and the patient feels revived by its use, it cannot be
objectionable. The same may be said of malt liquor,
premising that it be mild ale, well " hopped," as it is
in the Indian pale ale. All beverages should be taken
cool, or cold.

AVhenever the strength of the patient and the state
of the weather will permit, gentle exercise should be
taken daily in the open air ; when unable to walk, he
should be driven a short distance in an open carriage,
or in a garden chair ; in the absence of these luxuries,
he may sit for a short time in a garden, or other dry,

8

86 CONSUMPTION.

healthy place, where he can inhale a pure, mild atmos-
phere.

PREVENTION OF CONSUMPTION.

In considering this all-important subject, I shall com-
mence at the origin of the evil, and this, in an immense
majority of cases, is Hereditary Transmission.

It would be foreign to this work to discuss the hith-
erto inexplicable power which man possesses, of trans-
mitting peculiarity of talent, of form, of defect, in a
long line of hereditary descent ; we must be contented
with the fact that he has that power — that Avit, beauty,
and genius, dullness, madness, and deformity, are thus
propagated to a future lineage ; and that a host of
fearful diseases, as gout, consumption, scrofula, and
leprosy, originating, perhaps, in the first sufferer acci-
dentally, are propagated so deeply and so extensively,
that it is difficult to meet with a family whose blood is
totally free from all hereditary taint. Burton — the
quaint, the sententious, but truthful, Burton — says,
" Such as the temperature of the father is, such is the
son's ; and what disease the father had when he begot
him, his son will have after him ; and is as well the in-
heritor of his infirmities as of his lands."

The health of the parents influences the health of
the child. What are the conditions of the health that
induce a liability to consumption in the offspring ? Sir
James Clark says, " The belief that scrofulous parents
onlyhave consumptive children, is an error that cannot

PREVENTION OF CONSUMPTION. 87

be too soon corrected. A deranged state of the health
in the parent, from many different causes, may render
the offspring predisposed to tuberculous consumption."
Every member of the profession, by observing what is
daily passing before him, can obtain abundant evidence
of the truth of this statement : he will find that when
the parents are unhealthy, the children are so likewise,
and that the latter often show evident signs of the
tuberculous constitution when the former have no
symptoms of it. The children of parents who have
suffered long from dyspeptic complaints, gout, syphilis,
imprudent courses of mercury, cutaneous affections, or
any malady which has debilitated the system, are very
frequently the subjects of tuberculous disease, or of
such derangements as dispose to the tuberculous consti-
tution.

The importance, therefore, of considering the health
of the parent as the most effectual means of checking
the extension of consumption, must be admitted ; and
I fear we must be content with the admission. Is a
thought ever bestowed on this subject in matrimonial
alliances ? The liability to disease, hereditary or ac-
quired, is overlooked, or never cared for, in opposition
to personal attraction, mental acquirements, three per
cents., and influential connections.

A contemporary writer has well observed—" It may
be justly said, that, under no circumstances, should
legislative enactments interfere with domestic affections
and the bonds of society ; but as there is no rule de-
void of exceptions, so, when insanity is hereditary in a

00 CONSUMPTION.

family, the welfare of society demands that its members
should be debarred from matrimonial alliances." I do
not ask whether consumption may be substituted for
insanity in the above sentence ; but I state my opinion,
that when both the man and the woman are tainted
with a tuberculous constitution, marriage, under such
crrcumstances, should be forbidden by prudence, if not
by civil rule.

When a disposition to consumption exists in a family,
" there can be no question," says Mason Good, " that
inter-marriages among the collateral branches tend
more than any thing else to fix, and multiply, and
aggravate it ; there is reason to believe that unions
between total strangers, and perhaps inhabitants of
different countries, form the surest antidote. For, ad-
mitting that such strangers to each other may be taint-
ed on either side with some morbid predisposition,
peculiar to their respective lineages, each must lose
something of its influence by the mixture with a new
soil ; and we are not without analogies to render it
probable that, in their mutual encounter, the one may
even destroy the other by a specific power. And
hence, nothing can be wiser, on physical as well as
moral grounds, than the restraints which divine and
human laws have concurred in laying on marriages be-
tween relations."

Mr. Mayo, in his " Outlines of Physiology," ad-
vances the opinion that the physical and moral consti-
tution of the infant has a greater resemblance to that
of the father than to that of the mother. If this be

PREVENTION OF CONSUMPTION. 89

correct, the health of the infant would be dependent in
a greater degree upon the health of the father than the
mother. The doctrine, however, in relation to form,
complexion, and moral character, has so many excep-
tions, that its correctness seems doubtful. Be this as
it may, the young mother should know that the health
of her infant depends on her own, and that, from the
commencement of pregnancy, she must consider her-
self responsible, to a great degree, for the health of her
offspring ; whatever interferes with the regular action
of her several functions, especially digestion and its
product nutrition, interferes with the growth, the de-
velopment, and the constitution of the child yet unborn,
and irregularity or carelessness at this period may
entail upon her infant the most dire afflictions.

We will now consider the prevention of consumption
in infancy and childhood, and the means by which we
may improve the constitution, so as to overcome the
hereditary predisposition. Our helpmates, whilst the
infant is " mewling and puking in the nurse's arms,"
are proper diet, pure air, and religious cleanliness. If
the child derive its consumptive constitution from both
parents, or from the mother only, the latter must be
deprived of her sweetest privilege — that of suckling
her own child ; if, on the other hand, the predisposi-
tion be acquired from the father, and the mother's
health be unexceptionable, this restraint need not be
imposed. Food of " Nature's cooking, a mother's
milk," is the natural sustenance of infancy. When a
stranger's breast has to afford this, the greatest care is

90 CONSUMPTION.

demanded in the selection of the " wet nurse ": she
must be healthy herself, and of healthy parentage ; in
age she should not exceed thirty ; her child should not
be more than six or eight weeks old, and her temper
should be good and placid, as the secretion of milk is
naturally affected by irritability and passion.

It is a common error with healthy mothers to suckle
their children for twelve, eighteen, or twenty months,
to the risk of their own health and the injury of the
child. Soon after the appearance of the teeth, the
stomach of the infant is capable of digesting artificial
food, and the milk of the mother is, after the eighth or
ninth month, deteriorated in quality and insufficiently
nutritive : the child should then be weaned.

In consequence of ill-health, disease, or death of the
mother, it may become compulsory to rear the children
" by hand " — that is, entirely on prepared food ; and
certainly this mode, hazardous as it is, is preferable to
nursing with the milk of a parent affected with con-
sumption. An artificial milk, which approaches in
quality that of the mother, may be made with two
thirds of cow's milk, and one third of water, to which a
little sugar is to be added ; this forms a good substitute,
and should be made fresh as often as the child requires
it. The French prefer diluting cow's milk with an
equal quantity of fresh whey. Biscuit, powdered and
boiled with milk, water, and sugar, is also well suited
to the delicate stomachs of infants. Arrowroot, of all
vegetables, is the least disposed to fermentation, and
forms an excellent food, either with milk, or with water

PREVENTION OF CONSUMPTION. 91

and sugar. It is very common in this country for
people to give their children the worst food possible —
namely, flour boiled in milk, which, when taken into
the stomach, ferments, and fills the intestinal canal with
wind and acidity. Not any animal food should ever
be given to an infant under nine months old.

Happily the day has gone by when the new-born
babe was swathed and rolled in flannels and bandages
until deprived of all power of motion ; yet, at the pres-
ent time, dear old grandmammas and pertinacious
Sarah Gamps adhere too closely to the unhealthy cus-
tom of their childhood, and " long clothes," rollers, and
night-caps, still improperly maintain their place in the
nursery. It is a sadly mistaken notion to suppose that
we can give strength to a delicate and puny infant by
keeping it constantly in an artificial state ; an infant
confined in a heated chamber, lumbered with a supera-
bundance of clothing, must of necessity become so
tender and susceptible as to take cold upon any and
every alteration of temperature to which it may be ex-
posed.

In the early infancy of children, we must endeavor
to adopt the feelings and constitution of the child to
the climate and circumstances by which it is surround-
ed, rather than accommodate and regulate the atmos-
phere and dress to the supposed limited endurance of
the child : our aim being to give to the infant an innate
and native power of resistance ; to render it a hardy
perennial, not a tender hot-house annual. The clothing
should be sufficient to preserve the body at a proper

92 CONSUMPTION.

warmth, but not abundant or heavy ; calico is the only
fabric to be worn next the skin, and this should be
changed every night and morning ; and at the same
periods the child should be washed or plunged in cold
water, and a genial reaction induced by gentle rubbing
with towels. The importance of pure air cannot be
too highly estimated, and when the infant can breathe
that of the country, it possesses the best antidote to
tuberculous disease.

Were I to detail all the painful and trying struggles
to which infancy is liable, as teething, convulsions, the
eruptive fevers, &c, I should travel far from our pres-
ent subject ; I may, however, remark that, as in the
robust child these affections jeopardize the safety and
future health, so in the delicate or strumous child, they
are doubly hazardous, and demand constant and sedu-
lous attention.

In boyhood, the diet should be nourishing and gen-
erous without being stimulating ; animal food should
be given in larger quantities than to those in perfect
health ; vegetables should be allowed sparingly, and a
moderate quantity of good beer taken daily. Exer-
cise in the open air must be obtained whenever the
atmosphere is dry and warm, and if it can be accom-
plished, a residence during the summer and autumn
near the sea shore is desirable. Exercise at this age
is a natural want, essential to train the muscles to
their requisite offices, and to insure to the frame its
full development and just proportions. So strong, in-
deed, is this tendency to motion, that few punishments

l'UEVENTION OF CONSUMPTION. 93

are more grievous to childhood than such as impose re-
straints upon it.

There is great mismanagement in those female
boarding-schools where out-of-door games are prohibit-
ed, and the unfortunate inmates are restricted to a
stately walk in the garden, or a still more stately walk
along the foot-paths, in pairs, in stiff and monotonous
formality, resembling, as Dr. Beddoes justly remarks,
a funeral procession, and wanting nothing to funereal
solemnity but the feathers and the hearse. The conse-
quence is, that the muscles of the upper extremities,
and those concerned in the support of the trunk, are
rarely called into active play, and they do not acquire
strength as the body increases in stature.

Little bodily restraint should be imposed on children
for the first six or eight years ; long and irksome con-
finement to the sitting, or indeed to any one position,
and especially in close rooms, cannot but be inimical to
the just and healthy development of their physical con-
stitution. It is better that they be allowed to choose
their own muscular actions — to run, jump, frolic, and
use their limbs according to their own inclinations ; or,
in other words, as nature dictates — than to be subject-
ed to any artificial system of exercise. In children of
weakly constitutions, severe mental application is, in a
particular measure, hazardous. Whenever a precocity
of intellect, or a disposition to thinking and learning in
advance of the years, is displayed, to the neglect of
the usual and salutary habits of early life, it should be
restrained rather than encouraged ; the physical edu-

94 CONSUMPTION.

cation should ever be of paramount regard ; the future
health — for the absence of which life has no recom-
pense — being closely dependent on its judicious man-
agement. The practice, unfortunately too common, of
selecting the most delicate child for the scholar, is
founded in error. This is the very one whom it be-
comes most necessary to devote to some calling which
demands physical action and exposure to the open air.

A proper and moderate use of the vocal organs, at
this age, is of considerable advantage : reading aloud
is the best method of training the voice and expanding
the lungs ; and if, at the same time, the pupil be
taught the graces of declamation, and the natural ges-
tures of the orator, the benefit will be enhanced. It
is well known that Cicero, in early life, was predis-
posed to consumption ; and Cuvier attributed his ex-
emption from pulmonary disease, to which he was ex-
pected to fall a sacrifice, to the increased strength
which his lungs acquired in the discharge of his duties
as public lecturer.

Bathing, and " the art of swimming," should form a
part of every boy's early education : to the child pre-
disposed to consumption, the frequent ablution of the
whole body is of the most essential service : it gives
tone and vigor to the frame, frees the pores of the skin
from those impurities which are constantly accumula-
ting, and the muscular exertion which swimming de-
mands, is so universal, that not one part of the body is
affected in a greater degree than another. A bath
used early in the morning is most invigorating ; it pre-

PKEVENTION OF CONSUMPTION. 95

serves the body during the day at an equal tempera-
ture, and enables us to bear with less risk of annoyance
any sudden change in the climate. When a bath, or
bathing, cannot be conveniently obtained, the body,
particularly the chest, should be freely sponged with
cold water, and afterwards moderate friction should be
applied by means of a coarse towel. Those who have
never enjoyed this luxury, and have now the courage
to commence, will not willingly lay it aside. Sea
bathing is a prophylactic of the greatest value ; and
whenever the position of the parents of a scrofulous
child will permit, he should reside, during the summer
months of his early life, on the coast, to obtain the
constant advantage of this really necessary adjuvant to
health.

The period of life at which youth advances to adult
age, termed puberty, extending in males from fifteen
to eighteen, and in females, in our climate, from twelve,
thirteen, or fourteen, to sixteen, is one of great im-
portance to the future life of every individual ; but
important in an especial degree to such as may be pre-
disposed to consumption. At this age, the develop-
ment of the vital system is perfected, and the form in-
creases in strength and symmetry. The boy throws
off the puerile character, and starts at once a man ; his
countenance is illumined with intellect and decision ;
his voice assumes a rough and manly tone ; his limbs
are firm, his step erect and vigorous. In the female
these characteristic changes are equally marked, and
constitute the first eriaia in woman's life ; if possible,

96 CONSUMPTION.

the body undergoes a greater change, and becomes
more fully developed ; the bust is enlarged ; the neck
elongated ; the eye sparkles with vividness and ex-
pression indicative of soul and feeling ; girlish playful-
ness is exchanged for bashfulness and retiring modesty,
and in her deportment the girl gradually merges from
a child and assumes a womanly character.

" By degrees
The human blossom blows ; and every day,
Soft as it rolls along, shows some new charm ;
The father's lustre, and the mother's bloom." — Thompson.

It will be readily understood that every circum-
stance which interferes with this natural development,
and, to a certain extent, perfection of the human frame,
must involve the present and future health ; and that
every thing that can deprive the body of strength pro-
portionate to its increasing growth, must induce that
debility which best fosters consumption. At this age
the body should be nourished by wholesome diet, and
the hitherto wavering mind tutored to constant and
unyielding virtue.

The too early age at which children are confined to
laborious or sedentary occupations has been, and is, a
crying evil of our generation. Wherever there exists
a probability of the tuberculous constitution, it cannot
be other than condemning the youth to certain and not
far distant disease, to immure him within a crowded,
ill-ventilated manufactory, and thus deprive him of the
only means by which threatened ill-health may be ar-

PREVENTION OF CONSUMPTION. 97

rested — namely, exercise, not exhaustion or fatigue, in
the open air. Young persons who are pressed into
such service, and have learnt to become a part of its
machinery almost before they have learnt their mother
tongue, are wasted, emaciated beings ; without the
innate power to resist the most trivial disease, they
cannot acquire the strength of a renewed constitution,
so as to ward off, or " grow out" such a fearful disease
as consumption.

The selection of a proper occupation for a delicate
or scrofulous youth, and at the age at which he should
commence the business of life, is an affair of no small
importance. lie should not be confined in crowded,
heated, ill-ventilated factories ; nor employed in any
sedentary business, as that of a tailor, shoemaker,
watchmaker, &c. ; nor as a clerk at the desk, nor an
engraver ; he must not breathe an atmosphere loaded
with irritating particles, as in weaving, milling, grind-
ing, &c. When, as too frequently happens, the future
" business " of youth is dictated by necessity, rather
than selected by choice, he should be taught the value
of such counteracting influences to an unhealthy occu-
pation as are within his reach. Amongst these maybe
named regularity in diet, regularity in the hour of
going to rest and in rising ; personal cleanliness ; bath-
ing ; the use of dumb-bells ; fencing, or single stick ;
walking exercise, daily ; boating, or cricket, occasion-
ally — it should be his aim to gain for himself a certain
amount of endurance and resistance, by moral and
physical training ; to give tone and vigor to his organi-

98

CONSUMPTION.

zation; and to earn for himself a new constitution; and,
truly, if the same pains were taken to acquire this new
constitution, as are frequently adopted to destroy a
good one, the art of acquiring health would not be
difficult or novel.

The girlhood of females demands all a mother's care
and solicitude ; it is now that the buds of inherent or
acquired disease are matured or crushed, and the pros-
pect of continued health and strength permanently
influenced ; it is now that the slightest deviation from
accustomed or expected habits must be noticed with
unremitting accuracy, and the indication thus afforded
so acted upon, that we may gently assist Nature,
rather than rashly or violently interfere with her beau-
tiful operations.

I have, in practice, daily to combat the erroneous
opinions of over-indulgent mothers, that a "delicate"
girl is unable or unfit to walk, hop, or run, as her
fancy may dictate ; and that she must be restrained in
her movements, fettered in stays, and confined in a
chamber warmed to fever heat. If it is wished that a
delicate girl should become a sickly woman, such would
be the plan to follow : but, if we desire to banish this
delicacy and susceptibility, and give health and energy
to the growing frame, we must allow Nature an op-
portunity of exerting her own powers ; we must depend
upon the influence of air, exercise, diet, and rest, with
occasional tonics and cold bathing.

In the early life of females strict attention should be
paid to the carriage, and the proper expansion of the

PREVENTION OF CONSUMPTION. 99

chest; calisthenics is an useful auxiliary to health,
insuring at the same time ease and grace of movement.
In reference to this suhject, the late Dr. Good says,
" Surely it is not necessary, in order to acquire all the
air and gracefulness of fashionable life, to banish from
the hours of recreation the old rational amusements of
battledore and shuttlecock, of tennis, trap-ball, or any
other game that calls into action the bending as well
as the extending muscles, gives firmness to every organ,
and the glow of health to the entire surface." To
prove the benefit of air and exercise, we have only to
contrast the damp hair, the pallid features and attenu-
ated form of the young milliner, confined in a heated
room for sixteen or eighteen hours, with the rosy tint
and bloom of health in the more fortunate girl who is
allowed to take her daily promenade.

Whilst guiding the physical education or "training"
of a young person affected with a consumptive diathe-
sis, we should not neglect the moral and intellectual
culture. The passions now begin to exert a powerful
influence on the health ; it is now that the mind rushes
into a new world, and is prone to receive lasting im-
pressions either of good or evil ; new thoughts, new
feeling?, engage the attention ; and the ideas and hab-
its now acquired, whether amiable or vicious, frequent-
ly become a part of our future existence. It is neces-
sary that all gloomy and dispiriting ideas should be
. dispelled, and whatever tends to depress the mind or
lower the animal spirits should be avoided with the
greatest circumspection.

100 CONSUMPTION.

That painful and exhausting emotion, compounded
of hope, love, and fear, which is distinguished by the
term longing, frequently agitates the delicate at this
age, and its effect on the health illustrates the striking
and beautiful apophthegm of the wise man, — " Hope
deferred maketh the heart sick." It is felt by children
who are at a distance from home, and who are eager
to return to the embrace of their parents ; by foreign-
ers, who have a strong and inextinguishable love for
their country, and are anxious to return to the scenes
and companions of former times ; and by the youthful
pair who have vowed an eternal attachment, but whose
union is opposed by bars that are felt to be insurmount-
able. Whenever the health suffers from despondency
occasioned by such separation, or by other depressing
emotions, which may be classed as heart-ache, it should
be the first care of those solicitious for the individual
to lessen, and, if possible, remove the corroding care
which oppresses the whole system.

The greatest discretion should be exerted in the
selection of those who are to become the intimate com-
panions of youth ; there are so many circumstances
dependent on this choice, that materially affect the
future health and well-being of the rising man, which
every parent will readily comprehend, that they require
only to be attended to, in order that their importance
may be acknowledged.

Intemperance, excesses of all kinds, precocity, and
all things that tend to induce nervous irritability and
muscular debility, readily become the parent of con-

PREVENTION OP CONSUMPTION. 101

sumption ; to those already predisposed to the disease,
they frightfully hasten its development.

The climate most favorable to preventing or retard-
ing the development of tuberculous consumption, is
that which is of a mild, dry, and equable temperature ;
hence a change of abode has been recommended in all
ages to those whose native soil is subject to considera-
ble and sudden variations. Nice, Naples, Madeira,
Malta, Sicily, and other islands in the Mediterranean,
and Penzance, the south-western boundary of the Cor-
nish coast, Devonshire, Hastings, and the Isle of
Wight, in our own country, afford this mildness and
equability, and are chiefly resorted to by consumptive
patients.* The most equal of all temperatures is that

* St. Augustine, Key West, Key Biscayne, Tampa Bay, in the
U. S. A. ; and Cuba in the West Indies.

Tlmsc invalids who seeh a southern climate during our winter to
escape the cold and variable weather which characterizes the season
here, usually go too Late, and much more frequently return too early to
reap the full benefit of the change, and to escape the evil which they
seek to avoid. Our inclement weather often begins in October, and
generally lasts till the middle of June. It is generally supposed that if
invalids arc absent during the interval when the thermometer is liable
to go below the freezing point, or there is a probability of frosts, they
are safe. This is a great mistake. It is not the cold simply which they
wish to escape. Some of the coldest northern climates are the most
exempt from consumption. Iceland, according to the report of Dr.
isner, is remarkably spared by this disease. Indeed it is doubtful
whether an extreme northern is not more exempt than an extreme
equatorial climate. The irregularity of the climate has quite as much,
probably much more to do with the development of the disease than
either extreme. Statistics in this country go to show that where the
climate is modified by the neighborhood of large bodies of water, and
rendered more equable as in the vicinity of the ocean, or of our great
hikes, the ravages of consumption are l"ss marked. There are no

102 CONSUMPTION.

of the sea, and many invalids who feel inconvenience
from a residence on the sea-side, are almost instantly
relieved by sailing a few miles distant from it. Sea-
sickness, when not too violent, is of unquestionable ser-
vice in many cases. The exercise of sailing affords

months of the year in our eastern and middle states more trying to
pulmonic patients than May, and the first half of June. And yet inva-
lids generally, if not strictly cautioned to the contrary, make their
arrangements to return during those months. The fresh winds and
cold storms which are the characteristic features of the month, with an
occasional mild, or extremely hot day to tempt the unwary, or force
the wisest to throw aside their protecting flannels, make a much great-
er impression upon a person laboring under any affection of the lungs,
than the steady cold of December and January. Our bills of mortality
show it. Many a sick one whose disease has resisted the cold of winter,
is cut down by the fluctuations of spring.

A gradual is more favorable than an immediate return to the north.
In our country the location of the different stages is such as to make
this exceedingly easy and agreeable. Having passed the winter in
Cuba, Key West, or Tampa Bay, the invalid may in March proceed to
St. Augustine, remain there to the end of May or June, then advance
to Savannah, and thence north by the first of July, when our summer
as regards invalids has commenced. The statistics of Dr. Fony, drawn
from many reports of posts in different parts of the country, show that
the mortality from pulmonary affections is least in the northern and
greatest in the middle and southern states. The mortality of the posts
at the north is 2 . 1, per 1000 strong. At the south it is 4 . 4, per 1000.
The last includes Florida. If we strike off E. Florida and the Lower
Mississippi, in which the mortality is only 1 . 7, the disproportion is still
greater. This, however, is the mortality among strangers who are
residents in the place the year round. Among them consumption is in
a majority of cases only the termination of other diseases, peculiar to
the climate, and to which strangers are peculiarly liable, and which are
induced at a season when it would be no benefit to pulmonic invalids
to visit those regions. It does not forbid, therefore, invalids with pul-
monic affections to visit those regions at a season when they are in all
respects healthy, and peculiarly favorable to those diseases which
suffer most in a rigorous or variable climate.

PREVENTION OF CONSUMPTION. 103

motion without exertion, or, at least, with no more ex-
ertion than gives a pleasurable and tranquilizing feel-
ing to the system ; it cheerfully engages the mind,
retards the pulse, calms the irregularities of the heart,
and produces sleep.

Sailing on the Tiber was a common prescription
among the Roman physicians. Steaming on the
Thames should be the daily medicine of such as are
disposed to the disease, and cannot travel a greater
distance.

To prevent the ravages of consumption in one al-
ready predisposed, especial attention must be paid to
nourishment, air, and exercise, so that he may be
placed in circumstances the most favorable to acquire
robust health: by removing functional derangements
as they occur ; by maintaining a healthy condition of
the digestive organs ; and, above all, by obtaining
prompt and efficient counsel on the advent of the slight-
est pulmonary disturbance, we may confidently hope so
to invigorate the constitution, as to turn aside and
overcome the liability to tuberculous disease.

Reviews of "Dr. Yeoman on Consumption."

FROM ENGLISH PUBLICATIONS.

"This dreaded enemy (Consumption) whicli attacks tlie young and
the lovely, no less than the old and weary, lias found aa able adversary
in Dr. Yeoman. — Of the causes, symptoms, and treatment of this dis-
ease Dr. Yeoman speaks in a clear and masterly manner. — The con-
cluding chapter is devoted to what is, after all, the main point to be
considered, viz. : what are the means of prevention ? In this depart-
ment the author has shown his intimate knowledge of his subject." —
People's Journal.

"All who are predisposed to consumption should read the book; and
even those who have no apprehension of this dread disease, may gather
from the little work before us many valuable and useful hints for the
preservation of the health that they fortunately possess." — Sherborne
Journal.

" Its appearance, at this season of the year, is very opportune, be-
cause of the very valuable instructions it contains respecting clothing.
The advice, also, on the subject of diet and regimen generally, in a pre-
ventive point of view, is, in our opinion, full of sound reasoning, and
worthy the attention of all who have the charge of youth — there is
much in the preventive treatment recommended by Dr. Yeoman, with
that object, that is worthy of the most careful observance." — Stockport
Advertiser.

" We have perused this little production, and have examined into its
merits conscientiously, and can aver that, as a medical work for the
people, it stands very high. It is written in a plain, intelligible style,
and is without the self-praise so usually attendant upon medical publi-
cations. We recommend to all a perusal of this unostentatious yet ex-
cellent little work." — Nottingham Mercury.

"Dr. Yeoman enters fully into the cause, symptoms, and rational
treatment of this ' plague spot of our climate' — points out the means of
prevention — and where those may fail he notices, with confidence, the
treatment which he has adopted for the amelioration of this ' melancholy
and pitiless disease.' As a work devoted to the history and nature of
' eni;:=i]mpHon,' this little volnm» is complete."— CfiHrch <? Bttltt Gnat "<■■

NOTICES. 105

" There is no assumption or quackery in this little Volume— it is just
such a work as might be anticipated from an intelligent and experienced
physician. The suggestions and recommendations of Dr. Yeoman are
extremely valuable, and may be unhesitatingly and advantageously
adopted by all who are interested m the health and well-being of the
rising generation." — Morning Herald.

" There is so much good sense, scientific knowledge, and useful in
formation in this little volume, that we gladly assist in giving it pub
licity. Dr. Yeoman discountenances all empirical modes of treatment,
at the same time that he suggests some safe and beneficial rules for the
cure or amelioration of the disease. The remarks on the healthy disci-
pline of home, show that the author is a sound social philosopher as
well as an experienced physician." — The Britannia.

" This compendious little treatise is marked by much good sense,
careful observation, and specific views as to the nature of the terrible
disease of which it treats. The subject is treated in a popular form :
and the volume should be consulted by every one who is interested in
this disease : and who is not, in this its favorite region ?" — Court Journal.

" Let us entreat particular attention to this little work, whose merits
are in inverse proportion to its magnitude. It bears evidence of great
common sense and absence of learned affectation and jobbery."— Lady's
Newspaper.

" We most cordially recommend the work to the heads of families,
and to the medical profession."— BeWa Wtekly Messenger.

" This little work, from the pen of a gentleman who has made pul-
monary complaints his special study, and who has acquired a well-de-
served celebrity by his mode of treating these terrible afflictions, will
be found a valuable addition to the medical library. Written unosten-
tatiously, and in a style which is earnest, though completely unaffected,
it may be studied with advantage by the general as well as the profes-
sional reader."— Weekly Dispatch.

" This may truly be called a work for all classes; for consumption is
the disease of all classes who breathe our humid and variable atmos-
phere The large proportion of deaths arising from this cause gives an
almost universal interest to the subject; and we have never seen it
treated with greater simplicity or practical sense than it is in the pages
of Dr Ykoman's unpretending little volume. There is noquackery.no
learned mystery, no affectation of originality in it; but a plain exposi-
tion of the causes, symptoms, aud rational treatment of the complaint,

106 NOTICES.

with the means most likely to be effectual in preventing it ; all set forth
with the clearness of a man who wishes to be understood, and the earn-
estness of a man who desires to be useful. We know that in all dis-
eases a timely application cf the remedy is more than half the battle,
And the aphorism which teaches that ' prevention is better than cure,
applies with peculiar force to the case of consumption, which, if once
established, rarely, if ever, gives way, even to the most skillful treat-
ment and the most sedulous care. Let all, therefore, as well those
who have no reason to apprehend the existence of the seeds of the
malady in themselves or their children, as those who have, read Dr.
Yeoman's book, they cannot fail to obtain much salutary advice with
reference to the regulation of their diet and the preservation of their
health." — Liverpool Courier.

" We much approve of Dr. Yeoman's work on consumption, it is a
straightforward, practically-written book, prepared for the public with
great research and attention, and we are sure that, if generally perused,
it would avert many dangerous consequences in complaints leading to
consumption. We have understood that Dr. Yeoman has been highly
successful in many cases of early consumption, and we prize his ef-
forts." — Blackwood's Lady's Magazine.

" The chapter on the ' Prevention of Consumption,' is excellent. It
is, in fact, a safe guide to acquire health. To the anxious parent, it
will prove a sympathizing, friendly counselor ; to the youthful, it will
be a monitor to direct them to health and vigor. We cordially recom-
mend the work to all our readers, and cannot but express our opinion
that Dr. Yeoman has done the ' state some service ' by its publica-
tion." — Preston Chronicle.

" The prescriptions are given in English ; and the medical phrases are
almost entirely left out. The chapter upon the ' Prevention of Con-
sumption,' and the paragraphs treating of the necessity of sufficient and
well-regulated exercise, a proper attention to personal cleanliness and
clothing, are particularly apt and good." — Leicester Journal.

" We can with sincerity state we never before read a work on the
causes, symptoms, and rational treatment, with the means of prevention
of consumption so satisfactory, and not its least recommendation is the
entire absence of medical technicalities. The style in which it is written
is easy and pleasing, and without exciting the mind of the reader, even
if he is, or thinks he is, of a consumptive habit, it gives him many use-
ful and valuable hints. We would recommend its perusal to the heads
of families." — Hampshire Guardian.

NOTICES. 107

" This is really an admirable little work on a subject, alas, too con-
genial to our climate. We speak conscientiously when we say that we
can heartily and strenuously recommend the work as plain, practical,
and rational — utterly devoid of mystification, without a trace of empi-
ricism. The causes of disease are distinctly pointed out; the symptoms
so vividly delineated that he who runs may read them ; and the best
treatment clearly and concisely unfolded. To consumptive patients
and consumptive families this little volume is a treasure ; and how
many such patients and families there are in England, let the Registrar-
General and the Bills of Mortality bear witness." — Cambridge Advertiser.

" This is a very well-written treatise on that horrible plague-spot of
our climate, consumption. The advice given is excellent— the treat-
ment rational, and there is good encouragement held out that by a
judicious use of the remedies prescribed, life may be much lengthened,
even in bad cases, though the disorder itself may not be eradicated."—
Hampshire Advertiser.

" In the production of this little work, Dr. Yeoman has conferred a
boon on society : without overloading his pages with those technicalities
which would render it unintelligible to the non-professional reader, he
places the insidious malady on which he treats in a plain, tangible form
as, and enables the most unacquainted with medics 1 matters, to
become familiar with its causes, its symptoms, and lucidly exhibits its
remedy. This work we would recommend to the attention of our
readers."— WaU rford Mail.

" This book will be found specially useful to those who wish to avoid
the common disease of consumption. Besides being scientifically
Written, it is popularly written, and will be extensively circulated."—
Glasgow Examiner.

" This is a sensible and unpretending little brochure. The symptoms,
the progress, and treatment of the disease, are ably and familiarly de-
scribed, and the prescriptions given are expressed in plain English, an
improvement wc hope some day to find universally adopted.-'-iancos-
ter Go

.. his treatment is of the safe kind. The volume is popular

and plainlyVritten."— Spectator.

« There is much to be learned from Pi-Roman's work that must be
of service to the afflicted and their fij~

VALUABLE BOOKS !

JAMES MUN110E AND COMPANY,

PUBLISH THE FOLLOWING :

NOTES ON CUBA; — Containing an Account of its Discovery and
Early History, a Description of the Face of the Country, its Population,
Resources, and Wealth ; its Institutions, and the Manners and Customs
of its Inhabitants, with Directions to Travelers visiting the Island. By
a Physician. One vol., 12mo., 360 pp., cloth. $1.00.

" A well-written, carefully-printed, and instructive book, by a physi-
cian. No invalid who seeks the blissful climate of Cuba should leave
home without this best of all guides and counselors. We are delighted
with the valuable contribution which be has made to history, as well as
with the intelligence and good judgment he evinces as a physician." —
Boston Medical Journal.

WYMAN ON VENTILATION A Practical Treatise on Ventilation.

By Morrell Wyman, M. D. 82 Cuts. 12mo. 436 pp.

" This will be found a very useful book on a subject intimately con-
nected with comfort and health." — Examiner.

THE SICK CHAMBER,— A Manual for Nurses. 18mo. Cloth. 25c.

41 A small but sensible and useful treatise, which might be fittingly
entitled the Sick Room Manual. It is a brief outline of the necessary
cares and precautions which the chamber of an invalid requires, but
which even quick-sighted affection does not always divine." — Atlas.

" It is not a medical treatise, but a practical instructicn-book for the
performance of the common offices cf a sick-chamber." — Courant.

PARKMAN'S OFFERING OF SYMPATHY.— Offering of Sympa-
thy to the Afflicted ; especially to Parents bereaved of their Children.
Being a Collection from Manuscripts never before published. With an
Appendix of Extracts. Third Edition. 18mo. Cloth. 63c.

" Though small, it is rich in comfort and instruction." — Miscellany.

" It has carried comfort to many a heart. We wish it well on its
errand of peace." — Christian Examiner.

CONSOLATIO,— or Comfort for the Afflicted, with a Pre-
face and Notes, by the Eev. P. H. Greenleaf, M. A. One vol. 16mo.
pp. 264. 63 cents.

CATARRH, INFLUENZA, BRONCHITIS, and ASTHMA ;—

their Causes, Symptoms, and Rational Treatment. By. Dr. Yeoman.

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